, Chan Ik Park, Jae Hun Kim, Chang Won Kim , Jae Hun Kim, Sun Hyun Kim 
, Jae Hun Kim, Sun Hyun Kim 
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, Sung Jin Park, Chan Ik Park, Seon Uoo Choi, Jae Hun Kim 
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An isolated pancreatic transection due to blunt trauma is a rare occurrence that usually requires surgical treatment. Non-surgical treatment for a pancreatic transection remains controversial because of its associated complications. On the other hand, non-surgical treatment has been used increasingly as a treatment option with promising results in recent years. A patient presented with a suspected pancreatic injury caused by a motorcycle accident. The computed tomography findings revealed an isolated pancreatic neck transection with a small amount of fluid collection. He was hemodynamically stable without signs of peritoneal irritation. Endoscopic retrograde pancreatography and stent insertion were performed. The patient had no significant complications and was discharged on day 18. The stent was removed on day 103 and the patient showed good recovery. For an isolated pancreatic transection, endoscopic intervention can be considered as an alternative with a good outcome in selected patients.
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.
Citations
A peripherally inserted central catheter (PICC) provides effective, reliable intravenous access in patients who require long term therapy such as intravenous antibiotics, total parenteral nutrition, transfusion or inotropic agents. This retrospective study evaluated the usefulness of PICC in trauma patients by examining patient characteristics and common complications, including PICC related bloodstream infection.
We reviewed the trauma patients who underwent PICC at Pusan National University Hospital Trauma Center from January 2016 to February 2017.
From January 2016 to February 2017, 32 patients underwent PICC. Total catheter insertion days were 875 days, and the average catheter indwelling time was 27.3±25.02 days. The most common indication for PICC was total parenteral nutrition (n=20, 62.5%), while the remainder was to ensure a long-term fluid administration route (n=12, 37.5%). Catheter related complications included infection (n=3, 9.4%; 3.42 per 1,000 catheter-days), catheter tip malposition (n=2, 6.3%), catheter dislodgement (n=1, 3.1%), insertion site leakage (n=1, 3.1%) and arm swelling (n=1, 3.1%). No statistically significant differences were found between those who developed bloodstream infection and those who did not.
If the PICC is performed by correcting adjustable factors that increase the risk of infection, effective and reliable intravenous access can be maintained in patients who require long-term therapy without bleeding, pneumothorax, or other complications of central venous catheter insertion.
Hemorrhage is the major cause of death in patients with severe trauma. The early coagulopathy that occurs in patients with severe trauma, known as acute traumatic coagulopathy (ATC), has a major effect on morbidity and mortality. About a quarter of all patients with severe injury are reported to have coagulopathy at the time of arrival to hospital. The important mechanism of ATC is hyperfibrinolysis by up-regulation of activated protein C. Therefore anti-fibrinolytics are needed to treat trauma patients with ATC. Tranexamic acid (TXA) is a common anti-fibrinolytic broadly used in clinical practice. TXA is a lysine analogue and binds to lysine-binding site on plasminogen, interfering with plasminogen binding to fibrin. By inactivating plasmin, TXA can prevent hyperfibrinolysis. Clinical randomization of an anti-fibrinolytic in significant hemorrhage-2 proved TXA effective for patients significantly bleeding from traumatic injuries, reducing mortality in bleeding trauma patients without increasing the risk of thrombosis. The results of this trial led many trauma centers to include TXA in their major hemorrhage protocols. Early use of TXA is the simplest and most effective treatment to improve patient outcomes in trauma patients with significant hemorrhage. Therefore use of TXA should be considered in patients with major trauma.
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