Traumatic pancreatic injuries are rare, but their diagnosis and management are challenging. The aim of this study was to evaluate and report our experiences with the management of pancreatic injuries.

We identified all adult patients (age >15) with pancreatic injuries from our trauma registry over a 7-year period. Data related to patients’ demographics, diagnoses, operative information, complications, and hospital course were abstracted from the registry and medical records.

A total of 45 patients were evaluated. Most patients had blunt trauma (89%) and 21 patients (47%) had pancreatic injuries of grade 3 or higher. Twenty-eight patients (62%) underwent laparotomy and 17 (38%) received nonoperative management (NOM). The overall in-hospital mortality rate was 24% (n=11), and only one patient died after NOM (due to a severe traumatic brain injury). Twenty-two patients (79%) underwent emergency laparotomy and six (21%) underwent delayed laparotomy. A drainage procedure was performed in 12 patients (43%), and pancreatectomy was performed in 16 patients (57%) (distal pancreatectomy [DP], n=8; DP with spleen preservation, n=5; pancreaticoduodenectomy, n=2; total pancreatectomy, n=1). Fourteen (31%) pancreas-specific complications occurred, and all complications were successfully managed without surgery. Solid organ injuries (n=14) were the most common type of associated abdominal injury (Abbreviated Injury Scale ≥3).

For traumatic pancreatic injuries, an appropriate treatment method should be considered after evaluation of the accompanying injury and the patient’s hemodynamic status. NOM can be performed without mortality in appropriately selected cases.

Blunt cardiac injuries (BCI) have a wide clinical spectrum, ranging from asymptomatic myocardial contusion to cardiac rupture and death. BCIs rarely require surgical intervention, but can be rapidly fatal, requiring prompt evaluation and surgical treatment in some cases. The aim of this study was to identify potential factors associated with in-hospital mortality after surgery in patients with BCI.

The medical records of 15 patients who had undergone emergency cardiac surgery for BCI between January 2014 and August 2020 were retrospectively reviewed. We included trauma patients older than 18 years admitted to Regional Trauma Center, Gachon University Gil Medical Center during the study period. Clinical and laboratory variables were compared between survivors and non-survivors.

Non-survivors showed a significantly higher Injury Severity Score (p=0.001) and Abbreviated Injury Scale in the chest region (p=0.001) than survivors. American Association for the Surgery of Trauma-Organ Injury Scale Grade V injuries were significantly more common in non-survivors than in survivors (p=0.031). Non-survivors had significantly more preoperative packed red blood cell (PRBC) transfusions (p=0.019) and were significantly more likely to experience preoperative cardiac arrest (p=0.001) than survivors. Initial pH (p=0.010), lactate (p=0.026), and base excess (BE; p=0.026) levels showed significant differences between the two groups.

Initial pH, lactate, BE, ventricular injury, the amount of preoperative PRBC transfusions, and preoperative cardiac arrest were potential predictors of in-hospital mortality.

Although the Advanced Trauma Life Support (ATLS) course is now taught internationally, it has not been implemented in Korea. In recent years, interest has increased in simulation as a teaching tool in the ATLS course. We therefore hypothesized that simulation training would be a useful adjunct to the ATLS course.

We designed a 1-day curriculum that included skill development workstations, expert lectures, trauma patient simulations, and group discussion for general surgery residents. We conducted a survey to evaluate participants’ level of understanding of the initial evaluation and treatment of trauma patients, their degree of knowledge and technical improvement, their satisfaction with the learning goals, and their overall satisfaction with the curriculum. We then analyzed the effects before and after the training.

Nine residents attended this course. None of the residents initially reported that they could perform a primary survey of trauma patients. The analysis revealed significant improvements after training in the questionnaire areas of “assembly of the team and preparation for resuscitation of a trauma patient” (p=0.008), “performance of a primary survey for trauma patients” (p=0.007), “resuscitative procedures for trauma patients” (p=0.008), “importance of re-evaluation” (p=0.007), “identifying the pitfalls associated with the initial assessment and management” (p=0.007), and “importance of teamwork” (p=0.007).

After the ATLS simulation training, all participants showed significant improvements in their understanding of how to manage multiple trauma patients. Therefore, ATLS simulation training for residents will help in the management of trauma patients.