The concept of acute care surgery (ACS) incorporates trauma, surgical critical care, and emergency general surgery. It was designed in the early 2000s by the United States as a solution to the looming crisis of trauma care and non-trauma emergency surgery. Reduced surgical opportunities for trauma surgeons resulted in a decreased interest in trauma surgery. Surgical sub-specialization further accelerated an indifference towards trauma and emergency general surgery. Started in 2008, the trauma center project in Korea is still in its infancy. Although the need for ACS was presented since the inception of the trauma center project, there was a lack of implementation at trauma centers due to government regulations. However, ACS has been initiated at several non-trauma center hospitals and is mainly operated by surgical intensivists. Studies demonstrate that adding emergency surgery to a trauma service does not compromise the care of the injured patients, despite an increase in trauma volume. Positive impacts of ACS are reported by numerous researches. We believe that the development and advancement of trauma centers will necessitate a discussion for the implementation of the ACS model at trauma centers in Korea.
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Creatine kinase (CK) elevation is caused by rhabdomyolysis, intense exercise, muscle damage, and several drugs. This study evaluated the clinical significance of elevated serum CK levels in patients with an intensive care unit (ICU) and their effects on muscle strength.
The database of 179 patients, who were examined with CK at least once among patients in the Samsung Medical Center ICU database, was reviewed retrospectively. Forty- eight patients with a myocardial infarction were excluded and 131 patients were analyzed. The clinical features of patients with an elevated CK of more than 2,000 IU/L (more than 10 times the normal value) and those who did not were compared.
The ICU stay days were longer in the high elevation group than the other group (8.6 days vs. 21.7 days, p=0.002). The high elevation group was more likely to go to other treatment centers than home after discharge (14.6% vs. 60.0%, p=0.007). When the Medical Research Council scale was measured, the score of the high elevation group was lower than that of the other group (17.2 vs. 13.3, p=0.006).
Patients with high CK levels were more likely to receive invasive treatment in the ICU, so their muscle strength may decrease with increasing ICU stay and were less likely to be discharged home because of difficulties in living alone. Therefore, in patients with high CK, anticipating long-term treatment in an ICU, minimizing muscle loss, and maintaining functional muscle strength through active rehabilitation will be helpful for the prognosis of the patient.
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To assess the prevalence of multidrug-resistant organisms (MDROs) in inter-hospital transferred critically ill patients.
This is a retrospective study. The study population comprised patients who were transferred from other hospitals or health care units into the medical or surgical intensive care unit of Samsung Medical Center from January 2012 to December 2014. We evaluated the acquisition of clinically significant MDROs including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria, and carbapenem-resistant Gram-negative bacteria (CRGNB).
Three hundred and twenty-one patients were included in this study. One hundred and fifty-one patients (47.0%) had at least one species of MDRO, 21.5% in MRSA, 27.1% in VRE, 15.6% in CRGNB, and 3.7% in ESBL. The prevalence of MDROs was significantly higher in male (52.7%), patients with diabetes (61.6%), patients with combined infectious diseases (51.6%), and medical patients (49.3%). Patients with MRSA had significantly longer length of stay than the patients without MRSA. The patients with CRGNB had higher mortality than the patients without CRGNB.
The prevalence of MDROs in inter-hospital transferred critically ill patients was very high. Patients with MDROs in this study had longer hospital stay and higher mortality. These patients require more attention for isolation and hygiene protocols, and antibiotic choices.
Traumatic carotid-cavernous fistula (TCCF) is a pathologic communication between the internal carotid artery and cavernous sinus, and is associated with craniomaxillofacial trauma. TCCF are very rare, occurring in 0.17∼0.27% of craniomaxillofacial trauma cases. We describe a 76-year-old woman treated for multiple fractures including the skull base, left temporal bone, right tibia and fibula, left clavicle, and fifth and seventh rib fractures. She developed symptoms of TCCF two weeks after the initial trauma. We successfully treated her by endovascular occlusion of the internal carotid artery.
This study evaluates respiratory complications related to nasogastric feeding tube insertion in intensive care units (ICU).
This was a retrospective, observational study undertaken in adult intensive care units between August 1, 2014 and October 31, 2014. Critically ill patients who had small-bore feeding tubes for enteral feeding inserted in ICUs comprised the study sample. Information collected by medical record review included demographics, clinical characteristics, and data related to the feeding tube insertion (mechanical ventilator, artificial airway, Glasgow Coma scale, confusion assessment method for the ICU, sedative drug use, postplacement X-ray, and complications).
Two hundred and seventy-six patients were included in the study sample. The median age was 64, and male patients were 67% of the sample. One hundred and eighty-nine patients (69%) were treated with a mechanical ventilator and 215 patients (78%) needed an endotracheal tube or tracheal cannula during feeding tube insertion. Twelve feeding tubes (4%) were inserted into patients' tracheobronchial trees and four pneumothoraxes (1.4%) were checked by postplacement X-ray.
Respiratory complications associated with feeding tube insertion are not rare. Such complications can lead to significant morbidity and mortality. Practitioners should be cognizant of the potential risks of feeding tube insertion. Standard protocol should be considered to minimize the risk.
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