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Case Report
Various injury patterns due to combustion (typical but unfamiliar to physicians and easy to miss) in Korea: a case report
Hyung Il Kim
J Trauma Inj. 2023;36(4):393-398.   Published online November 30, 2023
DOI: https://doi.org/10.20408/jti.2023.0060
  • 605 View
  • 17 Download
AbstractAbstract PDF
Patients transported from fire sites may exhibit various injury patterns. Major trauma, skin burn, inhalation burn, and carbon monoxide poisoning are typical injuries. However, most physicians may be unfamiliar that cyanide poisoning can frequently occur due to combustion. Cyanide poisoning is highly significant owing to high mortality and the existence of antidotes. I present a 35-year-old man who was transported from a burning building and suffered severe metabolic acidosis despite no major bleeding as well as mild carbon monoxide poisoning. I suspected cyanide poisoning and administered the antidote; subsequently, the patient showed improvement. The next day, sudden airway obstruction developed, and emergency endotracheal intubation was performed. The inhalation damage was detected only in the lower airway tract and not in the upper airway. Physicians should be aware of cyanide poisoning and inhalation burn to avoid missing treatment opportunities.
Summary
Original Articles
No frequency change of prehospital treatments by emergency medical services providers for traumatic cardiac arrest patients before and after the COVID-19 pandemic in Korea: an observational study
Ju Heon Lee, Hyung Il Kim
J Trauma Inj. 2023;36(3):172-179.   Published online August 2, 2023
DOI: https://doi.org/10.20408/jti.2023.0009
  • 1,208 View
  • 59 Download
AbstractAbstract PDF
Purpose
Out-of-hospital traumatic cardiac arrest (TCA) often has a poor prognosis despite rescue efforts. Although the incidence and mortality of out-of-hospital cardiac arrest have increased, bystander cardiopulmonary resuscitation (CPR) has decreased in some countries during the COVID-19 pandemic. In the prehospital setting, immediate treatment of cardiac arrest is required without knowing the patient’s COVID-19 status. Because COVID-19 is usually transmitted through the respiratory tract, airway management can put medical personnel at risk for infection. This study explored whether on-scene treatments involving CPR for TCA patients changed during the COVID-19 pandemic in Korea.
Methods
This retrospective study used data from emergency medical services (EMS) run sheets in Gangwon Province from January 2019 to December 2021. Patients whose initial problem was cardiac arrest and who received CPR were included. Data in 2019 were classified as pre–COVID-19 and all subsequent data (from 2020 and 2021) as post–COVID-19. Age, sex, possible cause of cardiac arrest, and treatments including airway maneuvers, oropharyngeal airway (OPA) or i-gel insertion, endotracheal intubation (ETI), bag-valve mask (BVM) ventilation, intravenous (IV) line establishment, neck collar application, and wound dressing with hemostasis were investigated.
Results
During the study period, 2,007 patients received CPR, of whom 596 patients had TCA and 367 had disease-origin cardiac arrest (DCA). Among the patients with TCA, 192 (32.2%) were pre–COVID-19 and 404 (67.8%) were post–COVID-19. In the TCA group, prehospital treatments did not decrease. The average frequencies were 59.7% for airway maneuvers, 47.5% for OPA, 57.4% for BVM, and 51.3% for neck collar application. The rates of ETI, i-gel insertion, and IV-line establishment increased. The treatment rate for TCA was significantly higher than that for DCA.
Conclusions
Prehospital treatments by EMS workers for patients with TCA did not decrease during the COVID-19 pandemic. Instead, the rates of ETI, i-gel insertion, and IV-line establishment increased.
Summary
Types of injuries caused by isolated electric scooter accidents
Kyongwon Yoo, Hyung Il Kim
J Trauma Inj. 2022;35(4):232-239.   Published online August 5, 2022
DOI: https://doi.org/10.20408/jti.2022.0010
  • 2,466 View
  • 56 Download
AbstractAbstract PDF
Purpose
The recent increase in electric scooter (e-scooter) use has been accompanied by an increase in injuries from e-scooter–related accidents. Studies have reported that most such injuries are minor, and physicians may therefore underestimate the severity of such injuries. This study investigated the types and severity of injuries caused by isolated e-scooter accidents (i.e., those that did not involve colliding with other cars or falling from heights).
Methods
This prospective observational study was conducted from May to December 2021 at our academic tertiary medical center. The demographic data of patients injured in isolated e-scooter–related accidents were collected. All injuries were categorized by body part.
Results
Fifty eligible patients visited our emergency department during the study period. Of these, 76% were categorized as nonemergency, and 62% were discharged after initial evaluation and treatment at the emergency department. Another 10% were admitted to the intensive care unit (ICU) and 18% to the ward, with nine patients receiving at least one operation. The average hospital stays were 2.4 days in the ICU and 9 days in the ward. One death occurred due to traumatic brain injury (overall mortality rate, 2%). Multiple fractures of the left third through ninth ribs combined with lung laceration and fractures of T12 and L4 were noted.
Conclusions
Various types and severities of injuries can occur in isolated e-scooter accidents. While most such injuries are minor, some will require ICU admission or surgery, and deaths can occur. Physicians should not underestimate the severity of such injuries.
Summary
The incidence of unexpected delays in uploading outside radiologic images in the transfer of patients with major trauma
Si Jun Woo, Yong Oh Kim, Hyung Il Kim
J Trauma Inj. 2022;35(2):92-98.   Published online May 11, 2022
DOI: https://doi.org/10.20408/jti.2021.0039
  • 1,804 View
  • 43 Download
AbstractAbstract PDFSupplementary Material
Purpose
Critically ill patients are frequently transferred from one point of care to a hospital that can provide a higher level of care. To achieve optimal treatment within the targeted window of time necessary for time-sensitive cases like major trauma, rapid transportation and decision making are essential. Transferred patients have often undergone radiologic imaging at the referring hospital. Examining these outside images is paramount. Therefore, this study was conducted to estimate the upload time of outside images.
Methods
This retrospective study was conducted from January to April 2020. Patients transferred from other hospitals with digitally recorded CDs or DVDs of radiologic or diagnostic images were included. When the patients were registered at the emergency department reception desk, the digital images were transmitted to our picture archiving and communication system using transmission software. The time of upload and the numbers of digital images were recorded. The time interval from patient registration to the time of upload was calculated.
Results
The median number of images was 688 in the trauma team activation (TTA) group (688 in the TTA group, 281 in the non-TTA trauma group, and 176 in the nontrauma group, respectively; P<0.001). The median upload time was 10 minutes. The longest upload time was 169 minutes. The upload time was more than 20 minutes in 12 cases (19.4%).
Conclusions
Patients with major trauma bring more images than patients with other diseases. Unexpected delays (>20 minutes) were noted in approximately 20% of cases. It is necessary to minimize this time.
Summary
Case Reports
Severe Airway Obstruction due to Massive Retropharyngeal Hematoma in a Warfarin-Taking Patient with a Normal International Normalized Ratio
Hyun Young Cho, Hyung Il Kim
J Trauma Inj. 2021;34(1):57-60.   Published online January 14, 2021
DOI: https://doi.org/10.20408/jti.2020.0028
  • 3,366 View
  • 83 Download
AbstractAbstract PDF

Warfarin is used as part of the treatment of various diseases, and laboratory monitoring of its effects is required. Airway hematoma secondary to warfarin is rare, but can be fatal because of potential airway obstruction. Rapid definitive airway establishment is crucial if airway obstruction is suspected. This complication is more likely to occur in those with elevated coagulation laboratory values. However, we experienced a patient in whom a massive retropharyngeal hematoma caused airway obstruction after a non-severe motor vehicle collision. The patient had been taking warfarin, and had coagulation parameter values within the normal ranges. A major fracture or hemorrhage was not anticipated. Upon examination, a massive retropharyngeal hematoma was noted. Orotracheal intubation failed due to an airway obstruction. Emergency tracheostomy and an operation for hematoma removal were performed. Physicians must always consider the possibility of airway hematoma in warfarin-taking patients with normal coagulation values regardless of the severity of mechanism of injury

Summary
A Carbon Monoxide Poisoning Case in Which Hyperbaric Oxygen Therapy Was Not Possible Due to Iatrogenic Pneumothorax after Unnecessary Central Catheterization
Hyung Il Kim, Seong Beom Oh
J Trauma Inj. 2019;32(4):252-257.   Published online December 30, 2019
DOI: https://doi.org/10.20408/jti.2019.040
  • 3,957 View
  • 48 Download
AbstractAbstract PDF

Hyperbaric oxygen therapy (HBOT) is used to treat carbon monoxide (CO) poisoning. However, untreated pneumothorax is an absolute contraindication for HBOT. More caution is needed with regard to monoplace hyperbaric chambers, as patient monitoring and life-saving procedures are impossible inside these chambers. Central catheterization is frequently used for various conditions, but unnecessary catheterization must be avoided because of the risk of infection and mechanical complications. Herein, we describe a case of CO poisoning in which iatrogenic pneumothorax developed after unnecessary subclavian central catheterization. The patient did not need to be catheterized, and HBOT could not be performed because of the pneumothorax. Hence, this case reminds us of basic—but nonetheless important—principles of catheterization.

Summary
Original Article
Mortality Reduction in Major Trauma Patients after Establishment of a Level I Trauma Center in Korea: A Single-Center Experience
Young Il Roh, Hyung Il Kim, Yong Sung Cha, Kyoung-Chul Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang, Oh Hyun Kim
J Trauma Inj. 2017;30(4):131-139.   Published online December 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.4.131
  • 4,010 View
  • 64 Download
  • 5 Citations
AbstractAbstract PDFSupplementary Material
Purpose

Trauma systems have been shown to decrease injury-related mortality. The present study aimed to compare the mortality rates of patients with major trauma (injury severity score >15) treated before and after the establishment of a level I trauma center.

Methods

During this 20-month study, participants were divided into pre-trauma center and trauma center groups, and trauma and injury severity score (TRISS) method was used to compare mortality rates during 10-month periods before and after the establishment of the trauma center (October 2013 to July 2014 vs. October 2014 to July 2015).

Results

Of the 541 total participants, 278 (51.5%) visited after the establishment of the trauma center. The Z and W statistics indicated better outcomes in the trauma center group than in the pre-trauma center group (Z statistic, 2.635 vs. ?0.700; W statistic, 4.640). The trauma center group also exhibited meaningful reductions in the time interval from the emergency department (ED) visit to emergency surgery (118.0 minutes vs. 142.5 minutes, p=0.020) and the interval from the ED visit to intensive care unit admission (202.0 minutes vs. 259.0 minutes, p=0.035) relative to the pre-trauma center group.

Conclusions

The TRISS and multivariate analysis revealed significant improvements in survival rates in the trauma center group, compared to the pre-trauma center group.

Summary

Citations

Citations to this article as recorded by  
  • Mortality Trends in Chest-Abdominal Trauma Patients Before and After the Establishment of Trauma Centers in South Korea
    Dae Ryong Kang, Hye Sim Kim, Ji Young Jang, Ou-Hyen Kim, Kiyoung Kim, Un Young Choi, Jiwool Ko, Keum Seok Bae, Hongjin Shim
    Journal of Acute Care Surgery.2024; 14(1): 1.     CrossRef
  • Intentionally self-injured patients have lower mortality when treated at trauma centers versus non-trauma centers in South Korea
    Jin Woo, Han Zo Choi, Jongkyeong Kang
    Trauma Surgery & Acute Care Open.2024; 9(1): e001258.     CrossRef
  • The Feedback Form and Its Role in Improving the Quality of Trauma Care
    Hany Bahouth, Roi Abramov, Moran Bodas, Michael Halberthal, Shaul Lin
    International Journal of Environmental Research an.2022; 19(3): 1866.     CrossRef
  • Survival benefit of direct transport to trauma centers among patients with unintentional injuries in Korea: a propensity score-matched analysis
    Dong Jun Lee, Seok Hoon Ko, Jongkyeong Kang, Myung Chun Kim, Han Zo Choi
    Clinical and Experimental Emergency Medicine.2022; 10(1): 37.     CrossRef
  • Machine Learning Model to Predict Ventilator Associated Pneumonia in patients with Traumatic Brain Injury: The C.5 Decision Tree Approach
    Ahmad Abujaber, Adam Fadlalla, Diala Gammoh, Hassan Al-Thani, Ayman El-Menyar
    Brain Injury.2021; 35(9): 1095.     CrossRef

J Trauma Inj : Journal of Trauma and Injury