symposium abstract bystep step · 2017-06-22 · we also devoted ourselves a collaboration between...
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
June 22 (Thu.) - 24 (Sat.), 2017
Seoul National University Bundang Hospital,Healthcare Innovation Park,Seongnam, Korea
teptep
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Scan the QR Code toOpen the Abstract Book
Giant Step toward Excellency of Trauma Care
Symposium Abstract
3
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Welcome Message
As a president of Korea Society of Traumatology, I deeply appreciate all the participants
joining this 5th Pan-Pacific Trauma Congress.
For last several years, we have put our whole effort in upgrading state-of-the-art trauma
care, education program, and scientific knowledge in traumatology. We also devoted
ourselves a collaboration between civil and military trauma system and as a result this
congress is co-hosted with Armed Forces Medical Command for many years. And we also
tried to have close cooperation with government to make our trauma care more faithful and
trustful to our people. I sincerely appreciate all the efforts made by all the members of our
society.
However, there are still a lot of works to do for the well-balanced maintenance of trauma
care, and pride for trauma surgeons. I truly believe that these problems can well improved
with our continuous efforts and dedication.
Thus, we are gathered here together to make a better understanding among us, and to
set a higher standard for the treatment of our patients. These efforts will surely result in
higher chance of survival in our patients, and eventually, better performance of our trauma
care. Moreover, which is expressed as a "Giant Step toward Excellency of Trauma Care"
slogan of this PPTC 2017, with our advanced skills, we will try to perform the best treatment
for trauma patients in Korea.
All renowned trauma surgeons and experts have gathered here from overseas or
domestically.
This conference will be giant step toward to excellency of trauma care.
I am also convinced that this conference will be best festive event for sharing cutting-
edge knowledge and deepening our friendship as well.
I hope all of you to enjoy this meeting.
Ho-Seong Han President of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Welcome Message
It is a great pleasure for me to co-host the 5th Pan-Pacific Trauma Conference with the
Korean Society of Traumatology and to invite trauma experts in the Pan-Pacific region.
Armed Forces Medical Command, under close collaboration with the Korean Society
of Traumatology, has been putting its utmost effort in enhancing the trauma-treating
capabilities based on " Patient First ". This conference would be great opportunity for us to
see our outcomes so far and check the direction we go.
Currently, the globe has confronted with diverse threats including mass disasters
numerous terrorisms. In particular, the Pan-Pacific region is faced with frequent natural
disasters such as earthquake, volcano eruption, typhoons and also threats from North
Korea. Close collaboration and active response between relative institutions are inevitable to
minimize the damages from those disasters and threats.
In this point of view, the theme "Step by Step" of this year's conference is meaningful
to achieve people's health and national safety as common goals. As this confernce makes
academic exchanges between experts of both military and civilian possible, I believe it
will be a great opportunity to develop the bond of sympathy and reinforce the mutual
collaboration system that achieves the common goals. In addition, I am expecting that the
development of traumatology in military medicine through this conference can be a great
help to the establishments of Armed Forces Trauma Center and truthful medical support
system.
Thank you.
Jong-Seong Ahn Commanding General, Armed Forces Medical Command, ROK
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Program at a Glance
22 June (Thu.)
23 June (Fri.)
Main Auditorium Seminar 1,2 Small Auditorium Seminar 5
08:00-08:30 Registration
09:00-10:30
5th NICE
(Nurse Intensive Care Education) Course 4th Military Trauma
Nurse Education Session
7th TREE
(Trauma Registry for Expert & Educator) Course
10:30-12:00
Military EMT Seminar12:00-13:00
13:00-16:00
16:00-18:00
18:00-
Main Auditorium Seminar 1 Seminar 2 Small Auditorium
Seminar 5
08:30-09:00 Registration
Poster Presentation
09:00-10:20Training Course 1 (KR)
Chest trauma/Hemorrhage
Training Course 2 (KR)Intensive Career Training
Course
Training Course 3 (KR)Traumatic
CardiopulmonaryArrest (TCPA)
10:20-10:40 Coffee Break
10:40-10:50 Opening Address
10:50-11:50Plenary Session 1
Step by Step 2017
11:50-12:00Congratulatory
Remark
12:00-12:30Plenary Session 2
Step by Step 2017
(KST/JAST) Leadership
Meeting
12:30-13:30 Luncheon 1
13:30-14:10Special Lecture
Intensive CareMedicine
Special Lecture Diaster
Special Lecture REBOA
Poster Presentation
14:10-15:50
Japan-Korean Symposium 1 Trauma System
Symposium 1 Treatment of Vulnerable
Orthopedic Trauma Patients
Symposium 2 Bleeding Control in Pelvic
Fracture
15:50-16:10 Coffee Break
16:10-17:50
Japan-Korean Symposium 2 Surgery and ICU
Care in Polytrauma Patients
Symposium 3 Trauma in Special
Population
Symposium 4 Common Questions about
Neurotrauma : Non-Neurosurgeon's View
18:00- Gala Dinner : 7F. Bulgok Hall
1F.
1F. 1F. 1F.
1F. 4F.
4F. 4F.
4F.
6
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Program at a Glance
The session with this headphone sign will be translated.
24 June (Sat.)
Main Auditorium
Seminar 1 Seminar 2 Small Auditorium
Seminar 4 Seminar 5
08:30-09:00 Registration
Poster Presentation
09:00 - 10:30Plenary Session 3 Step by Step 2017
10:30 - 10:50 Coffee Break
10:50 - 12:30
Symposium 5 Trauma
Management Update
Symposium 6 Medical Treatment
Guidance Committee
Symposium 7 Nursing Roles in Trauma Center
Oral Presentation
1
12:30 - 13:30 Luncheon 2Trauma Center
Meeting
13:30 - 15:00Symposium 8
Trauma US
Symposium 9 The Future of Military
Trauma Care(Patient First in
Military Trauma)
Oral Presentation 2
Poster Presentation
Oral Presentation
3
15:00 - 15:30 Coffee break
15:30 - 17:00
Symposium 10 Current of Trauma
Center : Still Much to Be Improved
Oral Presentation 4
Oral Presentation 5
Oral Presentation
6
17:00 - 17:30 General Assembly
17:30 -Award & Closing
Ceremony
1F. 1F. 1F. 4F. 4F. 4F.
7
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Scientific Program
Registration
Physiology of Chest Trauma : Non-Compressible Torso
Management of Life-Threatening Chest Trauma : Resuscitative Thoracotomy
Surgical Rib Fixation
Post-Traumatic ARDS
Coffee Break
Opening Remark
Opening Remark
The Pathophysiology of Shock
The Shock Index Revisited
Date : June 23, 2017 (Fri.) 08:30-17:50Main Auditorium
08:30-09:00
09:00-09:20
09:20-09:40
09:40-10:00
10:00-10:20
10:20-10:40
10:40~10:45
10:45-10:50
10:50-11:20
11:20-11:50
000
022
025
027
031
035
Jung Joo Hwang (Eulji Univ. Hospital)
Sung Wook Chang (Dankook Univ. Hospital)
Soon-Ho Chon (Jeju Halla Hospital)
Seon Hee Kim (Pusan National Univ. Hospital)
Ho-Seong Han (President, The Korean Society of Traumatology)
Jong-Seong Ahn (Commanding General, Armed Forces Medical Command, ROK)
Hiroyuki Hirasawa (Chiba Univ. Graduate School of Medicine)
Akio Kimura (Chief of JAST)
Training Course 1 (KR) - Chest Trauma/Hemorrhage
Plenary Session 1 - Step by Step 2017
Director : Seon Hee Kim (Pusan National Univ. Hospital)Moderator : Dong Kwan Kim (Ulsan Univ. Hospital) / Dong Seok Moon (Korea Univ. Guro Hospital)
Director : Sung-Hyuk Choi (Korea Univ. Guro Hospital)Moderator : Ho-Seong Han (President, The Korean Society of Traumatology) / Jong-Seong Ahn (Commanding General, Armed Forces Medical Command, ROK)
I Opening Address I
8
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Congratulatory Remark
Congratulatory Remark
Suggestion of President for Traumatology
Antithrombin-III in the Treatment of Trauma Patients
Clinical Benefit of Volume Therapy with HES 130/0.4 in Trauma Patients
11:50-11:55
11:55-12:00
12:00-12:30
12:30-13:30
13:30-14:10
039
042
Keun-Young Yoo (President, Armed Forces Capital Hospital)
Akio Kimura (Chief of JAST)
Ho-Seong Han (President, The Korean Society of Traumatology)
Hang Joo Cho (The Catholic Univ. Hospital)
Karim Asehnoune (Univ. Hospital of Nantes)
Plenary Session 2 - Step by Step 2017
Luncheon Symposium (CJ) / Small Auditorium
Special Lecture - Intensive Care Medicine
Director : Young-Hoon Yoon (Korea Univ. Hospital)Moderator : Kang-Hyun Lee (Vice-President, The Korean Society of Traumatology)
Moderator : Kang-Hyun Lee (Vice-President, The Korean Society of Traumatology)
Director : Do Joong Park (Seoul National Univ. Bundang Hospital)Moderator : Do Joong Park (Seoul National Univ. Bundang Hospital)
I Congratulatory Address I
Date : June 23, 2017 (Fri.) 08:30-17:50Main Auditorium
Scientific Program
9
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Scientific Program
Prehospital Trauma Patients Management in Japan
Prehospital Trauma Patients Management in Korea
In Hospital Trauma Patients Management in Japan
In Hospital Trauma Patients Management in Korea
Coffee Break
Operative Management in Polytrauma Patients in Japan
Operative Management in Polytrauma Patients in Korea
Postoperative Management in Polytrauma Patients in Japan
Postoperative Management in Polytrauma Patients in Korea
14:10-14:35
14:35-15:00
15:00-15:25
15:25-15:50
15:50-16:10
16:10-16:35
16:35-17:00
17:00-17:25
17:25-17:50
18:00-20:00
045
044
050
052
1
056
058
062
064
Hayato Takayama (Nagasaki Univ. Hospital Regional Medical Support Center)
SungWoo Moon (Korea Univ. Hospital)
Takashi Fujita (Chairman, Committee on International Liaison, JAST Associate Professor, Trauma and Resuscitation Center, Teikyo University)
Hyun-min Cho (Pusan National Univ. Hospital)
Akihiro Usui (Sakai Municipal Hospital)
Chan Yong Park (Pusan National Univ. Hospital)
Nobuyuki Saito (Nippon Medical Univ. Chiba Hokuso Hospital)
Namyeol Kim (Korea Univ. Guro Hospital)
Japan-Korean Symposium 1 - Trauma System
Japan-Korean Symposium 2 - Surgery and ICU Care in Polytrauma Patients
Director : Gil Joon Suh (Seoul National Univ. Hospital)Moderator : Yasumitsu Mizobata (Osaka City Univ.) / Gil Joon Suh (Seoul National Univ. Hospital)
Director : Gil Joon Suh (Seoul National Univ. Hospital)Moderator : Yoshinori Murao (Kindai Univ.) / Chae-Hyuk Lee (COL, First ROK Army)
I Social Event (Gala Dinner) I - 7F. Bulgok Hall
Date : June 23, 2017 (Fri.) 08:30-17:50Main Auditorium
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Scientific Program
Date : June 23, 2017 (Fri.) 09:00-17:50Seminar 1
Hemodynamic Monitoring of the Injured Patient
Massive Pulmonary Embolism: Lyse, Suction or Operate?
Necrotizing Soft Tissue Infections: ICU Challenges
Update of New SCCM/ASPEN Critical Care Nutrition Guideline
Coffee Break
Trauma Management in Nuclear Warfare
09:00-09:20
09:20-09:40
09:40-10:00
10:00-10:20
10:20-10:40
13:30-14:10
067
070
074
076
085
Jin Wi (Yonsei Univ. Hospital)
Jae-Seung Jung (Korea Univ. Hospital)
(Gachon Univ. Gil Hospital)
Jae-Myeong Lee (Korea Univ. Hospital)
Chae-Hyuk Lee (COL, First ROK Army)
Training Course 2 (KR) - Management of Trauma Patients in ICU
Special Lecture - Diaster
Director : Namyeol Kim (Korea Univ. Hospital)Moderator : Jae Baek Lee (Chonbuk National Univ. Hospital) / Hee-Jin Yang (Seoul National Univ. Boramae Hospital)
Director : Hong-Chul Lim (Seoul Barunsesang Hospital)Moderator : Hong-Chul Lim (Seoul Barunsesang Hospital)
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Scientific Program
Date : June 23, 2017 (Fri.) 09:00-17:50Seminar 1
Physiological Changes of Elderly Trauma Patients
Orthopedic Trauma Treatment of Elderly Patients
Orthopedic Trauma Treatment of Pediatric Patients
Painful Memory Case I
Painful Memory Case II
Painful Memory Case III
Painful Memory Case IV
Coffee Break
14:10-14:24
14:24-14:38
14:38-14:52
14:52-15:02
15:02-15:16
15:16-15:30
15:30-15:50
15:30-16:10
088
090
092
094
096
097
100
Byungchul Yu (Gachon Univ. Gil Hospital)
Hoon-Sang Sohn (National Medical Center)
Joon-Woo Kim (Kyungpook Univ. Hospital)
Hyung-Keun Song (Ajou Univ. Hospital)
Jae-Hoon Jang (Pusan National Univ. Hospital)
Youngwoo Kim (The Catholic Univ. Hospital)
Jin-Kak Kim (Korea Univ. Hospital)
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Director : Yong-Cheol Yoon (Gachon Univ. Gil Hospital)Moderator : Beom Koo Lee (Armed Force Capital Hospital) / Kichul Park (Hanyang Univ. Hospital )
12
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Scientific Program
Date : June 23, 2017 (Fri.) 09:00-17:50Seminar 1
Management of Trauma in Pediatric Patients
Management of Trauma in Pregnant Women
Management of Trauma in Geriatric Patients: Rib Fracture in Octogenerian
Endovascular Treatment of Vascular Injury in the Military Soldiers
16:10-16:35
16:35-17:00
17:00-17:25
17:25-17:50
104
108
110
112
Min Koo Lee (Jeju Halla Hospital)
Seong Hwa Lee (Pusan National Univ. Hospital)
Chun Sung Byun (Yonsei Univ. Wonju College of Medicine)
Taeho Kim (Armed Forces Capital Hospital)
Symposium 3 - Trauma in Special Population
Director : Seon Hee Kim (Pusan National Univ. Hospital)Moderator : Kun Hwang (Inha Univ. Hospital) / Seogki Lee (Chosun Univ. Hospital)
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Scientific Program
Date : June 23, 2017 (Fri.) 09:00-17:30Seminar 2
Traumatic Cardiac Arrest - Similar but Different
Airway Matters in Maxillofacial Injury
Cardiac Arrest Associated with Chest Injury
Prehospital eFAST : Evidence-Based Recommendations
Coffee Break
REBOA
09:00-09:20
09:20-09:40
09:40-10:00
10:00-10:20
10:20-10:40
10:40-11:20
115
117
119
121
124
Jun-Dong Moon (Kongju National Univ. Hospital)
Young Hoon Yoon (Korea Univ. Hospital)
Jaykey Chekar (Mokpo Hankook Hospital)
Oh Hyun Kim (Yonsei Univ. Wonju College of Medicine)
Junichi Matsumoto (St. Marianna Univ. JAPAN)
Training Course 3(KR) - Traumatic Cardiopulmonary Arrest (TCPA)
Special Lecture - REBOA
Director : Jun-Dong Moon (Kongju National Univ.)Moderator : Sun Joo Wang (Hallym Univ. Hospital) / Min Koo Lee (Jeju Halla Hospital)
Director : Chan Yong Park (Pusan National Univ. Hospital)Moderator : Chan Yong Park (Pusan National Univ. Hospital)
14
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Scientific Program
Date : June 23, 2017 (Fri.) 09:00-17:30Seminar 2
Preperitoneal Pelvic Packing
Internal Iliac Artery Ligation
Bony Stabilization
Interventional Radiology
Panel Discussion
Coffee Break
Optimal BP & ICP & CPP in TBI Patients
Multimodality Monitoring in TBI Patients
Indications & Timing of Decompressive Craniectomy
Neurologic Sign and Neuroimaging Suggesting Poor Prognosis
Experiences of Spinal Trauma in Military Hospital
14:10-14:30
14:30-14:50
14:50-15:10
15:10-15:30
15:30-15:50
15:50-16:10
16:10-16:30
16:30-16:50
16:50-17:10
17:10-17:30
17:30-17:50
127
128
132
135
137
140
142
144
148
150
Ji Young Jang (Yonsei Univ. Wonju College of Medicine)
Ji Hoon Kim (Ulsan Univ. Hospital)
Ji Wan Kim (Inje Univ. Hospital)
Chang Won Kim (Pusan National Univ. Hospital)
Hwan Jun Jae (Seoul National Univ. Hospital)
Hyuck Jin Choi (Pusan National Univ. Hospital)
Jung-Ho Yun (Dankook Univ. Hospital)
Kum Whang (Yonsei Univ. Wonju College of Medicine)
Nam Kyu Yu (Ajou Univ. Hospital)
Sang Hoon Yoon (Armed Forces Capital Hospital)
Symposium 2 - Bleeding Control in Pelvic Fracture
Symposium 4 - Common Questions about Neurotrauma : Non-Neurosurgeon’s View
Director : Chan Yong Park (Pusan National Univ. Hospital)Moderator : Jeong Ho Kim (Gachon Univ. Gil Hospital) / Hang Joo Cho (The Catholic Univ. Hospital)
Director : Bo-Ra Seo (Mokpo Hankook Hospital)Moderator : In Ho Park (Mokpo Hankook Hospital) / Seong-Keun Moon (Wonkwang Univ. Hospital)
15
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Scientific Program
Registration
Management of Traumatic Patients in Japan
Surgical Management in Traumatic Patients
Trauma System in San Antonio Military Medical Center (SAMMC)
Coffee Break
Should TEG/ROTEM be a Standard of Trauma Care?
Retrohepatic IVC Injuries
Open or Closed? The MIS Applied to Trauma
Damage Control Surgery. Light and Dark Side
Date : June 24, 2017 (Sat.) 08:30-17:00Main Auditorium
08:30-09:00
09:00-09:30
09:30-10:00
10:00-10:30
10:30-10:50
10:50-11:15
11:15-11:40
11:40-12:05
12:05-12:30
154
156
158
162
167
171
174
Takashi Fujita (Chairman, Committee on International Liaison, JAST
Associate Professor, Trauma and Resuscitation Center, Teikyo Univ.)
Kenneth Mak (Khoo Teck Paut Hospital)
Kurt Edwards (COL, San Antonio Military Medical Center)
Jae Hun Kim (Pusan National Univ. Hospital)
John Cook-Jong LEE (Ajou Univ. Hospital)
Hang Joo Cho (The Catholic Univ. Hospital)
Namryeol Kim (Korea Univ. Hospital)
Plenary Session 3 - Step by Step 2017
Symposium 5 - Trauma Management Update
Director : Jongbouk Lee (National Medical Center)
Moderator : Jongbouk Lee (National Medical Center)
Kang-Hyun Lee (Vice-President, The Korean Society of Traumatology)
Director : Namyeol Kim (Korea Univ. Hospital)Moderator : Jung Nam Lee (Gachon Univ. Gil Hospital) / Jungchul Kim (Chonnam National Univ. Hospital)
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Scientific Program
Date : June 24, 2017 (Sat.) 08:30-17:00Main Auditorium
12:30-13:30
13:30-13:52
13:52-14:12
14:12-14:34
14:34-14:56
15:00-15:30
15:30-16:15
16:15-17:00
177
180
184
188
199
201
Luncheon Symposium (Green Cross) / Small Auditorium
Symposium 8 - Trauma US
Symposium 10 (KR) - Current of Trauma Center : Still Much to be Improved
Moderator : Gil Joon Suh (Seoul National Univ. Hospital)
Director : Oh Hyun Kim (Yonsei Univ. Wonju College of Medicine)Moderator : Il Ung Hwang (Former Commanding General, Armed Forces Medical Command, ROK) Young-Rock Ha (Bundang Jesaeng Hospital)
Director : Kang-Hyun Lee (Yonsei Univ. Wonju College of Medicine)Moderator : Hyun-min Cho (Pusan National Univ. Hospital) / Keum Seok Bae (Yonsei Univ. Wonju College of Medicine)
Fluid Resuscitation
Recent Updates in FAST from the Perspective of a Trauma Surgeon
Ultrasound Guided CVC in Trauma
The Role of POCUS in Cardiovascular Trauma
The Role of Lung US in Trauma
Coffee Break
Proposal for Improvement of the System for Dedicated Trauma Specialist
Outcomes of the Supporting Services for Installation of Regional Level 1 Trauma Centers
Kyu Seok Kim (Seoul National Univ. Bundang Hospital)
Hang Joo Cho (The Catholic Univ. Hospital)
Han-Ho Do (Dongguk Univ. Ilsan Hospital)
Bo Seung Kang (Hanyang Univ. Guri Hospital)
Young-Rock Ha (Bundang Jesaeng Hospital)
Hyun-min Cho (Pusan National Univ. Hospital)
Jong-Min Park (National Trauma System Management Office)
17
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Scientific Program
Date : June 24, 2017 (Sat.) 10:50-15:00Seminar 1
CPR in Blunt Trauma Patients: Indication and Contraindication, How long?
Vascular Access in Shock Patients: Who, When, Where, What, How, Why?
Crystalloid versus Colloid: Which on is Better for Shock Patients?
Initial Response to Trauma Team Activation: Which Specialists Should be Involved?
Trauma Team Leader: Emergency Physician vs. Trauma Surgeon
2016 Combat Orthopedic Trauma
Epidemiology of Burn in Military
What’s New in Traumatic Hemorrhagic Shock
Sharing Experience of Forward Surgical Team in Afghanistan
10:50-11:10
11:10-11:30
11:30-11:50
11:50-12:10
12:10-12:30
13:30-13:52
13:52-14:14
14:14-14:36
14:36-14:58
218
220
223
227
229
233
239
242
256
Soon Chang Park (Pusan National Univ. Hospital)
Junsik Kwon (Ajou Univ. Hospital Trauma Center)
Do Wan Kim (Chonnam National Univ. Hospital)
Maru Kim (The Catholic Univ. Hospital)
(Gachon Univ. Gil Hospital)
Jeong Kook Baek (MAJ, Armed Forces Ildong Hospital)
Jang-Kyu Choi (MAJ, Armed Forces Capital Hospital)
Hohyung Jung (CPT, Armed Forces Capital Hospital)
Kurt Edwards (COL, San Antonio Military Medical Center)
Symposium 6 (KR) - Medical Treatment Guideline Committee
Symposium 9 - The Future of Military Trauma Care, Patient First in Military Trauma
Director : Jung Joo Hwang (Eulji Univ. Hospital)Moderator : Seok Ho Choi (Dankook Univ. Hospital) / Jung Joo Hwang (Eulji Univ. Hospital)
Director : Duck Hyun Ryu (Armed Force Capital Hospital)Moderator : Byung-Seop Choi (COL, Armed Forces Medical Command) Beomman Ha (COL, Armed Forces Capital Hospital)
18
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Scientific Program
Date : June 24, 2017 (Sat.) 10:50-12:30Seminar 2
Trauma Bay
Trauma Intensive Care Unit
Physician Assistant
Registry
Performance Improvement
10:50-11:10
11:10-11:30
11:30-11:50
11:50-12:10
12:10-12:30
260
262
265
267
269
Sun Mi Kim (Pusan National Univ. Hospital)
Kyung Mi Kim (Dankook Univ. Hospital)
Myung Jin Jang (Gachon Univ. Gil Hospital)
Sang Mi Noh (Chonnam National Univ. Hospital)
Byungchul Yu (Gachon Univ. Gil Hospital)
Symposium 7 - Nursing Roles in Trauma Center
Director : Chan Yong Park (Pusan National Univ. Hospital)Moderator : Myung I Choi (Chonnam National Univ. Hospital) / Kyung Hag Lee (National Medical Center)
Training Course 1(KR)
Chest Trauma/Hemorrhage
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Seon Hee Kim (Pusan National Univ. Hospital)
Moderator
Dong Kwan Kim (Ulsan Univ. Hospital)
Dong Seok Moon (Korea Univ. Guro Hospital)
1F. Main Auditorium
06-23 (Fri.), 2017
20
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
08/2012 - 03/2007 PhD. in Immunology
Graduate School of Medical Science and Engineering , KAIST, Daejeon, Korea
02/2002 - 03/1998 MS in Anatomy
School of Medicine, Yonsei University, Seoul, Korea
02/1996 - 03/1990 MD in School of Medicine, Yonsei University, Seoul, Korea
2016.10.1- Present: Trauma Center, Eulji University Hospital, Daejeon, Korea
2014.9.1 2016.9.30: Associate Professor, Department of Trauma Surgery, PNUH
Department of Cardiothoracic Surgery, Eulji University Hospital, Daejeon, Korea
Department of Cardiothoracic Surgery, Gangnam Severance Hospital, Seoul, Korea
The Korean Society of Traumatology
The Korean Society for Thoracic & Cardiovascular Surgery
The Korean Society and European society of Critical Care Medicine
The Korean Association for the Study of Lung Cancer
Education
AcademicAppointments
ProfessionalAssociations
Jung Joo Hwang (Eulji Univ. Hospital)
Training Course 1(KR) - Chest Trauma/Hemorrhage
21
Training Course 1 (KR) - Chest Trauma/Hemorrhage
Physiology of Chest Trauma :
Non-Compressible Torso Hemorrhage
Jung Joo Hwang (Eulji Univ. Hospital)
Hemorrhage is the leading cause of potentially preventable death in both military and civilian
trauma, accounting for over 80% of deaths in recent reports. Significant hemorrhage originating
within the torso is particularly challenging as there is no reliable method of control without an
operating room or interventional suite. Approximately 15% of patients admitted to Level 1 trauma
centers in the US from 2007-2009 in the National Trauma Data Bank had NCTI (non-compressible
torso injury). NCTH(non-compressible torso hemorrhage) was associated with an extremely high
mortality rate of 45%, with torso vessel and pulmonary injury identified as independent predictors
of death. The importance of uncontrolled torso hemorrhage has been re-emphasized by US military
studies analyzing data from the wars in Iraq and Afghanistan. Torso hemorrhage was found to be
the leading cause of potentially survivable death. A further analysis of US military deaths from 2003-
2004 and 2006 showed that hemorrhage accounted for 87% and 83% of all deaths, respectively.
Among patients with hemorrhage, 50% were due to NCTH and 33% were due to extremity injury.
Identification of patient and injury factors associated with this lethal, yet potentially survivable
injury may help to channel timely interventions to improve survival/outcomes. Early identification
of patients with non-compressible torso hemorrhage (NCTH) may assist in prompt interventions
leading to improved survival. More recent guideline from the Western Trauma Association
(WTA), published in 2016, describes several “complimentary, and not mutually exclusive, options”
including pelvic stabilization, pre-peritoneal packing, REBOA, and endovascular therapy without
clear superiority of any one strategy. Further studies are needed and we hope that new treatment
options will be emerging soon.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
22
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Dankook University College of Medicine (Master of Medicine)
Resident in the Department of Thoracic Surgery, Dankook University Hospital
Clinical Instructor (fellowship), Seoul Samsung Hospital, Department of Thoracic
Surgery
Board of Trauma Surgery
Board of Critical Care Specialty
In Charge of General Affairs for The Korean Society for Thoracic & Cardiovascular
Surgery Congress
Korean Medical License
Director of Education Board in Korea Association for Research, Procedures and
Education on Trauma
Clinical Assistant Professor of Trauma Center, Thoracic Surgery in Dankook
University Hospital
Clinical Associate Professor of Trauma Center,Thoracic Surgery in Dankook
University Hospital
Education
Academic
Appointments
Sung Wook Chang (Dankook Univ. Hospital)
Training Course 1(KR) - Chest Trauma/Hemorrhage
23
Training Course 1 (KR) - Chest Trauma/Hemorrhage
Management of Life-Threatening Chest
Trauma : Resuscitative Thoracotomy
Sung Wook Chang (Dankook Univ. Hospital)
In 1874, Moritz Schiff described open cardiac massage as a resuscitative maneuver, and in 1966,
Beall wrote the important role of thoracotomy regardless of the location of the patient. However,
the limited success of resuscitative thoracotomy(RT) prohibited the use of the procedure. Especial-
ly, RT is rarely performed for damage control resuscitation in South Korea.
The aim of RT is as follows: to relieve cardiac tamponade, to perform open cardiac massage, to
control life-threatening intrathoracic hemorrhage, to control air embolism or bronchopleural fistula
and to occlude the thoracic aorta for improving cerebral, coronary circulation and decreasing in-
tra-abdominal and pelvic hemorrhage.
In general, current indication and clinical pathway of RT is as follow. (7th TRAUMA)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
And RT is contraindicated in the following situations:
1) Patients with no signs of life and blunt trauma requiring greater than 10 minutes of CPR
2) Penetrating trauma requiring greater than 5 min(non-torso), 15 minl(torso) of CPR
3) Severe brain injury
4) Pulseless to emergency department without signs of life after blunt
RT is a high-risk and low-survival procedure, but it may be a life-saving option for selected pa-
tients. RT remains unfamiliar procedures in South Korea, too. However, if education program is
provided to trauma physician, and consensus for RT is achieved, the probability of survival with RT
may be expected in South Korea.
25
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Clinical Fellowship, Department of Thoracic and Cardiovascular Surgery
Puchon Sejong Hospital, Puchon, Korea 3/2000 to11/2000
Supervised by Young Tak Lee, M.D., Ph.D. (Presently Chief Cardiothoracic Surgeon
at Samsung Medical Center)
Korean Medical Association - Lifetime Member
Korean Thoracic and Cardiovascular Surgery Society - Lifetime Member
Korean Tracheobronchial and Esophageal Surgery Society - Member
Doctor of Philosophy in Medicine (Ph.D. - August 1999)
Department of Thoracic and Cardiovascular Surgery Hanyang University Seoul,
Korea
Korean Board of Thoracic and Cardiovascular Surgery License
License to Practice Medicine in Korea License
PostDoctoral Fellowshipand Internships
ProfessionalAssociations and boardCertifications
Education andProfessional Certifications
CertificationLicensure
Soon-Ho Chon (Jeju Halla Hospital)
Training Course 1(KR) - Chest Trauma/Hemorrhage
26
Training Course 1 (KR) - Chest Trauma/Hemorrhage
Surgical Rib Fixation
Soon-Ho Chon (Jeju Halla Hospital)
Thoracic trauma is related to 25% trauma related mortality. Greater than 3 rib fractures is related
to higher risk of pulmonary complications and higher morbidity and mortality. Flail chest is a
generally accepted indication of rib fixation, however other indications are still a subject of debate.
The benefits of rib stabilization are becoming clear. There are shorter ICU and hospital stays,
lower rate of complications, shorter duration of mechanical ventilation, lower mortality rates, lower
risk of reintubation, decrease in need for tracheostomy, decrease in chest wall deformity, decrease
in pain, improved lung function, and increase in return to work. The suggested indications for
rib fixation are flail chest, 3 or more rib fractures with displacement, respiratory embarrassment,
uncontrolled pain in non-union fracture or overlapping fractures, lung impalement, open chest
defect, chest wall deformity, as adjunct to thoracotomy, and pulmonary herniation. The suggested
ideal timing for the operation is 24 to 72 hours after the traumatic event and 48 hours after
evaluation of head injury. VATS in rib stabilization is relatively new and the advantages will be
discussed. Common methods of rib fixation are relatively new. We have performed 31 cases in
Jeju in a 4 year period, 6 cases of which were performed in the last two months. A discussion of
some interesting cases will also be presented. More prospective and large multicentral studies are
needed to establish a standard in the indications for rib fixation.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
27
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Mar. 2012 - Feb. 2014
Completion the Course of Ph.D. of Medical Science
Pusan National University School of Medicine, Medical Research Institute,
Busan, Korea
Mar. 2011 - Feb. 2013
Fellowship in Department of Trauma Surgery
Pusan National University hospital, Pusan National University School of
Medicine
Medical Research Institute, Busan, Korea
May. 2013 -
Assistant professor, Trauma Surgery
Pusan National University Hospital, Pusan National University School of
Medicine
Medical Research Institute, Busan, Korea
Education
Post-Graduate
Training
Hospital
Appointments
Seon Hee Kim (Pusan National Univ. Hospital)
Training Course 1 (KR) - Chest Trauma/Hemorrhage
28
Training Course 1 (KR) - Chest Trauma/Hemorrhage
Post-Traumatic ARDS
Seon Hee Kim (Pusan National Univ. Hospital)
Acute respiratory distress syndrome (ARDS) is a potentially lethal problem in trauma
patients[1,2]. Based on the Berlin definition[3], the typical presentation of posttraumatic ARDS is
a hypoxemic status [an arterial oxygen tension(PaO2)/fraction of inspired oxygen (FiO2) ratio
≤ 300 mmHg with a positive end-expiratory pressure (PEEP) ≥5 cmH2O] that is accompanied
with bilateral pulmonary opacities, and occurs shortly after trauma. The common predisposing
factors of posttraumatic ARDS are blunt thoracic injuries, traumatic shock requiring massive blood
transfusion, and an injury severity score (ISS) ≥ 25 [2]. Similar to ARDS caused by nontraumatic
etiologies, posttraumatic ARDS is primarily treated with mechanical ventilation. To reduce the
injurious effects of cyclical inflation and deflation on the already injured lungs during positive
pressure ventilation, lung-protective ventilation is preferred among ARDS patients, using low tidal-
volumes (≤6 mL/kg/min) and optimal PEEPs to achieve an inspiratory plateau pressure(Pplt) ≤ 30
cmH2O [4,5]. However increases in FiO2, PEEP, and Pplt may be unavoidable when an acceptable
arterial oxygenation cannot be maintained. The hyperinflatedhyperoxic ventilation may exacerbate
pulmonary shunting and induce a repeated mechanical-biological trauma [6]. This ventilator-induced
lung injury may initiate a vicious cycle that leads to severe ARDS (PaO2/FiO2 ratio ≤100 mmHg)
with multiple organ dysfunctions [7]. Venovenous extracorporeal life support (VV-ECLS) may break
this vicious cycle by conducting a prepulmonary blood gas exchange to share the workload with
native lung, which enables physicians to continue lung-protective ventilation [8].
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
29
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
1. Salim A, Martin M, Constantinou C, Sangthong B, Brown C, Kasotakis G, Demetriades D,
Belzberg H: Acute respiratory distress syndrome in the trauma intensive care unit: Morbid but
not mortal. Arch Surg 2006, 141(7): 655-658.
2. Watkins TR, Nathens AB, Cooke CR, Psaty BM, Maier RV, Cuschieri J, Rubenfeld GD: Acute
respiratory distress syndrome after trauma: development and validation of a predictive model.
Crit Care Med 2012,40(8): 2295-2303.
3. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L,
Slutsky AS: Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012, 307(23):
2526-2533.
4. ᅟ: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute
lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress
Syndrome Network 1. N Engl J Med 2000, 342(18): 1301-1308.
5. Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, Schoenfeld D,
Thompson BT: Higher versus lower positive end-expiratory pressures in patients with the acute
respiratory distress syndrome. N Engl J Med 2004, 351(4): 327-336.
6. Gattinoni L, Carlesso E, Caironi P: Stress and strain within the lung. Curr Opin Crit Care 2012,
18(1): 42-47.
7. Quilez ME, Lopez-Aguilar J, Blanch L: Organ crosstalk during acute lung injury, acute respiratory
distress syndrome, and mechanical ventilation. Curr Opin Crit Care 2012, 18(1): 23-28.
8. MacLaren G, Combes A, Bartlett RH: Contemporary extracorporeal membrane oxygenation for
adult respiratory failure: life support in the new era 1. Intensive Care Med 2012, 38(2): 210-220.
Nevertheless, because of its inherent thrombogenicity owing to the blood-surface interaction [9],
VV-ECLS requires systemic heparinization and involves a 40% risk of hemorrhage at intracranial,
surgical, and cannulation sites[10]. This risk may increase when VV-ECLS is administrated to patients
who have just sustained major trauma and damage-control interventions. These patients tend to
have the trauma-induced coagulopathy (TIC) [11] and may be vulnerable to heparinization
Plenary Session 1
Step by Step 2017
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Sung-Hyuk Choi (Korea Univ. Guro Hospital)
Moderator
Ho-Seong Han (President, The Korean Society of Traumatology)
Jong-Seong Ahn (Commanding General, Armed Forces Medical Command, ROK)
1F. Main Auditorium
06-23 (Fri.), 2017
31
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Chiba University School of Medicine - form April, 1960 to March, 1966
Graduate School of Medicine, Chiba University - from April, 1967 to March, 1971
International Federation of Shock Societies (President, Congress President for
2016)
Society of Critical Care Medicine(Co-Chair for 2008 Meeting, Active Member)
The Shock Society (Active Member and Official Journal “Shock” Associate Editor)
European Shock Society (Active Member)
International Society for Artificial Organs (Active Member)
International Society of Blood Purification (Active Member)
Asia-Pacific Association of Critical Care Medicine (Council Member, Honorable
President for 2012 Congress)
Education
Membership in International Medical Society
Hiroyuki Hirasawa (Chiba Univ. Graduate School of Medicine)
Plenary Session 1 - Step by Step 2017
32
Plenary Session 1 - Step by Step 2017
The Pathophysiology of Shock
Hiroyuki Hirasawa (Chiba Univ. Graduate School of Medicine)
At the consensus conference on hemodynamic monitoring in shock being held in 2006,
three very important description concerning the definition of shock was proposed. Namely,
1) hypotension is not required to define shock, 2) As a result, assignment of the presence of
inadequate tissue perfusion on physical examination is important, 3) Only biomarker recommended
for diagnosis or staging of shock is blood lactate. Then in the next consensus conference on
hemodynamic monitoring on circulatory shock being held in 2014, it was proposed that shock
is best defined as a life-threatening, generalized form of acute circulatory failure associated with
inadequate oxygen utilization by the cells. They further described that shock is a state in which the
circulation is unable to deliver sufficient oxygen to meet the demands of the tissues, resulting in
cellular dysfunction. They also described that the result of such state is cellular dysoxia, i.e. the loss
of the physiological independence between oxygen delivery and oxygen consumption, associated
with increased lactate levels. Therefore, basically shock is the state of inadequate oxygen utilization
by the cell due to the circulatory failure which is best diagnosed with blood lactate level.
Traditionally shock was classified according to the causes of shock, such as hemorrhagic shock,
anaphylactic shock, neurogenic shock and septic shock. However, recent classification of the
shock is depend on the hemodynamic states of shock patients, and shock is classified into the
following four types: cardiogenic shock, hypovolemic shock, obstructive shock and distribute
shock. Among those four types of shock, distributive shock is most important. Distribute shock
may be subgrouped into two types: Septic shock and non-septic distributive shock. Vincent J-L
and colleagues reported that 62% of shock treated in ICU is septic shock and 4% is non-septic
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
33
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
distributive shock, which followed by cardiogenic shock (16%), hypovolemic shock (16%) and
obstructive shock (2%), respectively. So in clinical settings, the most important type of shock is
distributive shock, especially septic shock.
Among traumatized patients hypovolemic shock due to massive hemorrhage may be
developed immediately after injury. However, even traumatized patients often develop septic
shock during their clinical course through the complicated severe infection caused by post-injury
immunosuppression. Therefore, septic shock is important form of shock even to the trauma
surgeons.
Septic shock is developed basically through dysregulated host response by overwhelming
hypercytokinemia. Such hypercytokinemia is caused by overwhelming cytokine production
by many types of cells through the recognition of PAMPs (pathogen-associated molecular
patterns) such as LPS and the recognition of DAMPs (damage-associated molecular patters), or
sometimes referred to Alarmins, such as HMGB-1 by pattern recognition receptors such as toll-
like receptors. Furthermore such DAMPs include damaged tissues and damaged cells following
trauma and therefore, non-septic distributive shock could be developed following injury due
to hypercytokinemia through the recognition of DAMPs such as damaged tissues by pattern
recognition receptors. In the recent consensus statement (Sepsis-3), sepsis is defined as life-
threatening organ dysfunction caused by a dysregulated host response to infection and septic
shock is defined as a subset of sepsis in which underlying circulatory and cellular/metabolic
abnormalities are profound enough to substantially increase mortality.
Thus, the main pathophysiological features of septic shock are hypercytokinemia. And therefore,
some countermeasures against hypercytokinemia should be considered following the effective
therapeutic approaches to infection such as administration of adequate antibiotics and surgical
removal and/or drainage of infectious foci. We have reported that continuous hemodiafiltration
with cytokine-adsorbing hemofilter is an effective therapeutic approach to hypercytokinemia and
therefore to septic shock following the adequate approach to infectious foci.
34
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
References
1) Antonelli M, Levy M, Anderws PJD, et al: Hemodynamic monitoring in shock and implications
for management. International Consensus Conference, Paris, France, 7-28 April 2006.
Intensive Care Med 2007; 33: 575-90.
2) Cecconi M, De Backer D, Antonelli M, et al : Consensus on circulatory shock and
hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.
Intensive Care Med 2014; 40: 1795-815.
3) Vincent J-L, De Backer D: Circulatory shock. N Engl J Med 2013; 369: 1716-34.
4) Vincent J-L, Opal SM, Marshall JC, et al: Sepsis definitions: Time to change. Lancet 2013; 381:
774-5.
5) Singer M, Deutschman CS, Seymour CW, et al: The third international consensus definitions
for sepsis and septic shock (Sepsis-3). JAMA 2016; 315: 801-10.
6) Shiga H, Hirasawa H, Nishida O, et al: Continuous hemodiafiltration with a cytokine-
adsorbing hemofilter in patients with septic shock: a preliminary report. Blood Purif 2014; 38:
211-8.
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Mar. 1984: Graduated from Gifu University, School of Medicine
May 1984: Obtained the M.D. Degree
Dec. 1992: Obtained the Ph.D. Degree in Medical Science
Apr. 2005~: Granted the Guest Professor of Gifu University, School of Medicine
Apr. 2006~: Granted the Guest Professor of Tokyo Medical and Dental University,
School of Medicine
Apr 2014~: Professor of the Postgraduate School of Juntendo University, School of
Medicine
Faculty Member of Japanese Association for Acute Medicine
Chair of Executive Board of Japanese Association of Surgery for Trauma
Corresponding Member of American Association for the Surgery of Trauma
Member of International Association for Trauma Surgery and Intensive Care
Member of the Asian Association of EMS
AcademicBackground
Membership ofAcademicSociety
Akio Kimura (Chief of JAST)
Plenary Session 1 - Step by Step 2017
36
Plenary Session 1 - Step by Step 2017
The Shock Index Revisited
Akio Kimura (Chief of JAST)
Introduction: The shock index (SI) is heart rate (HR) divided by systolic blood pressure (SBP)
has been reported to be a more sensitive marker for shock than standard vital signs alone. The
revers shock index (rSI), namely SBP divided by HR, may be more suitable for practitioners.
Moreover, in patients aged >55 years, SI multiplied by age (SIA) might be a better predictor of early
post-injury mortality. On the other hand, the Glasgow Come Scale (GCS) Score has been proven
to be a strong predictor for mortality. For further development of all above ideas, we hypothesize
that the rSI multiplied by GCS score (rSIG) or the rSIG divided by age (rSIG/A) can be a better
predictor of survival or of requirement for early blood transfusion (BT).
Methods: This is a retrospective, multicenter study using 168,517 patients’ data obtained from
the JTDB for 2006-2015. calculated the areas under (AU) the receiver operating characteristic curves
(ROCC) to measure the ability of SI, SIA, SI/G, SIA/G, sSIG and rSIG/A to predict the hospital
mortality outcome and the 24-hour BT outcome. We compared AUROCCs and determined cut off
value of each predictor
Results: Among the caliculated values, the rSIG had the highest AUROCC for survival in
younger patients (<55 years old) and for 24-hour BT. The cut off values were six for survival and
nine for BT. In older patients (≥55 years old), The ROCC of the rSIG/A was the most sensitive for
survival with the cut off value of 0.2.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
37
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
Conclusions: The rSIG is easy to calculate at bed side and is a good predictor for both survival
and for early BT, with the cut off value of six and nine, respectively. In patients aged ≥55, The
rSIG/A should be used with the cut off value of 0.2.
Plenary Session 2
Step by Step 2017
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Young-Hoon Yoon (Korea Univ. Hospital)
Moderator
Kang-Hyun Lee (Vice-President, The Korean Society of Traumatology)
1F. Main Auditorium
06-23 (Fri.), 2017
39
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1978-1984 M.D., Seoul National University College of Medicine
1986-1988 M.S., Seoul National University College of Medicine
1989-1993 Ph.D., Seoul National University College of Medicine
1984-1985 Intern, Seoul National University Hospital
1985-1989 Resident, Department of Surgery Seoul National University Hospital
1989-1993 Assistant professor, Department of Surgery, Gyeongsang
National University College of Medicine
1993-2003 Associate professor & Chairman of Department of Surgery,
Ewha Womans University College of Medicine
2003- Present Professor of Department of Surgery Seoul National University
College of Medicine
2012- Present Director of Comprehensive Cancer Center Vice President in
Cancer and Neuroscience Seoul National University Bundang Hospital
2015- Present President, Korean Society of Traumatology
2008- Present President, Korean Study Group of Laparoscopic Liver Surgery
2012- 2014 Past President, Korean Study Group of Pancreas Surgery
2014- 2016 Past President, Korean Society of Surgical Metabolism and Nutrition
2014- 2016 Past Chairman of Board of Directors, Korean Society of Surgical Oncology
2016- Present Chairman of Board of Directors, Korean Society of Laparoscopic &
Endoscopic Surgeons*
2009- 2011 Chairman of Public Relations Committee, Korean Society of
Hepatobiliary Pancreas Surgery
Education &Degrees
Positions
Membership
Ho-Seong Han (President, The Korean Society of Traumatology)
Plenary Session 2 - Step by Step 2017
40
Plenary Session 2 - Step by Step 2017
Suggestion of President for Traumatology
Ho-Seong Han (President, The Korean Society of Traumatology)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
Special Lecture
Intensive Care Medicine
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Do Joong Park (Seoul National Univ. Bundang Hospital)
Moderator
Do Joong Park (Seoul National Univ. Bundang Hospital)
1F. Main Auditorium
06-23 (Fri.), 2017
42
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Karim Asehnoune got his degree as MD in 1999 at University René Descartes Paris, France. After
completing his PhD in immunology in 2001, he spent one year in the lab of Edward Abraham in Denver,
USA (2002). He was appointed Professor of Anaesthesiology and Critical Care Medicine in the University
of Nantes in 2009. Professor Asehnoune is the head of the Anaesthesiology department of Hospital Hotel-
Dieu, and the director of the 30-bed surgical Intensive Care Unit at the University hospital of Nantes,
France. He is currently member of the scientific committee of the French Society of Anaesthesiology and
Critical Care Medicine, and the director of a French network of ICUs (www.ATLANREA.org). Professor
Asehnoune was involved as the coordinator of several multi-centre trials, and he is the director of a lab
dedicated to the study of host-pathogen interactions (http://www.ea3826.univ-nantes.fr/). His main
focuses of interests are, severe trauma, and pulmonary complications, and immunodepression-induced
pneumonia after traumatic brain injuries. He has published more than 155 peer-reviewed articles.
Karim Asehnoune (Univ. Hospital of Nantes)
Special Lecture - Intensive Care Medicine
43
Special Lecture - Intensive Care Medicine
Clinical Benefit of Volume Therapy with HES
130/0.4 in Trauma Patients
Karim Asehnoune (Univ. Hospital of Nantes)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Gil Joon Suh (Seoul National Univ. Hospital)
Moderator
Yasumitsu Mizobata (Osaka City Univ.)
Gil Joon Suh (Seoul National Univ. Hospital)
1F. Main Auditorium
Japan-Korean Symposium 1
Trauma System
06-23 (Fri.), 2017
45
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1986: Graduated from Nagasaki University School of Medicine
1986: Junior Resident, National Hospital Nagasaki Central Hospital
1988: Surgeon, the Medical Union of Nagasaki Prefecture Hospitals
1996: Chief of Critical Care Medicine, National Hospital Nagasaki Medical Center
2010: Director of Critical Care Medicine, National Hospital Nagasaki Medical
Center
2016: Current Position
Medical Control Council of Nagasaki Prefecture
JPTEC Council Research Subcommittee,
JPTEC Kyushu Representative
Japanese Association for Acute Medicine
Japanese Society for Aeromedical Services Director
Conference for Emergency Medical in Rural Areas and Isolated Islands
Representative
Education
Professional
Experiences
Committee
Members
Hayato Takayama
(Nagasaki Univ. Hospital Regional Medical Support Center)
Japan-Korean Symposium 1- Trauma System
46
Japan-Korean Symposium 1 - Trauma System
Prehospital Trauma Patients Management
in Japan
Hayato Takayama (Nagasaki Univ. Hospital Regional Medical Support Center)
Background
The beginning of Pre-hospital Trauma care Japan (PTCJ) was brought to Japan in Nov. 1999, at
the workshop of the paramedic hold in Hiroshima. It was based on 2 American existing systems,
"Basic Trauma Life Support (BTLS)" and "Pre-hospital Trauma Life support (PhTLS)". Before this
introduction, Japanese pre-hospital system was based on paramedic's experience. The first PTCJ
seminar was hold on 2000, paramedics of all over Japan attended as students. On the next year,
2nd Seminar is learned by 16 leading ER doctor and paramedics in Japan.
For the making of system
We proceeded with the adaptation of PTCJ on "Ministry of health, labor and welfare" and
"Foundation for ambulance service development". PTCJ also in a request program of the Medical
control (MC) doctor, on examination committee of "Japanese Association for Acute Medicine." Two
groups surround Japanese emergency trauma system ware appeared on this time. "JPTEC council
" is in charge of pre-hospital field, they provide "JPTEC course". On the other one, " JTCR (Japan
trauma care and Research)" is in charge of in-hospital field.
Expansion of JPTEC
JPTEC council started operation as a lower branch of "Japanese Association for Acute Medicine."
Holding seminar for the sake of make a standard JPTEC course as part of medical control. JPTEC
became a standard of pre-hospital activity today. It spread to paramedics and also use in text of fire
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
47
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
academy.
Revised JPTEC guidebook was published on last year. 2 new courses, "first responder course "
for general public and "mini-course" for medical stuff are rolled on July 2016.
Our goal of future
JPTEC council will continue our effort to reduce traumatic death can be prevented, raise the
quality of paramedics, and disseminate not only whole health care workers, but also general
public.
48
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1996 : Korea University, College of Medicine, Seoul, Korea (Bachelor of medicine, MD)
2001-2003: Korea University Graduate School of Medicine (Master’s Degree)
2005-2008: Korea University Graduate School of Medicine (Ph.D.)
March 1996 - February 1997: Rotating Internship Korea University Medical Center,
Seoul, Korea
March 1998 - April 2001: Military service as an Army Doctor (Lieutenant)
May 2001 - February 2005: Residency, Emergency Department, Korea University
Ansan Hospital
March 2005 - February 2006: Clinical & Research Fellow, Emergency Department,
Korea University Ansan Hospital
March 2006 - February 2009: Clinical Assistant Professor, Emergency Department,
Korea University Ansan Hospital
March 2011 - August 2016: Associate Professor, Emergency Department, Korea
University Ansan Hospital
September 2016 - at present: Professor, Emergency Department, Korea University
Ansan Hospital
The Korean Council of EMS Physicians; Education Committee Chair
Gyunggido Emergency Medicine Service Center: Director
Ansan Fire Department: Medical Director
Education
Postdoctoral
Training and
Position
Professional
Societies
SungWoo Moon (Korea Univ. Hospital)
Japan-Korean Symposium 1- Trauma System
49
Japan-Korean Symposium 1 - Trauma System
Prehospital Trauma Patients Management
in Korea
SungWoo Moon (Korea Univ. Hospital)
In Korea, pre-hospital care for trauma patients is provided by EMS providers of fire department
(119), which is government agency. Korea has two level of EMS provider’s certification. Level 1
emergency medical technicians (EMTs) is compatible with emergency life-saving technician in
Japan, and they provide advanced skills including advanced airway, intravenous access and fluid
infusion. However, scope of practice for EMTs is relatively narrow compared to western country
such as US.
One of integral part in pre-hospital trauma care system is medical direction (direct and indirect).
Direct (on-line) medical direction is performed by certified medical directors at the central fire
agency office of each province. By on-line medical direction, EMS providers could make better
decision for severely injured patient care, destination hospital designation, etc. A total of 196
physicians are appointed as medical directors for 198 community fire departments, and they
actively involve quality improvement activities, including education and performance measure.
Inclusive trauma system derived from the idea that trauma care should be community based
rather than trauma center based, encompassing injury prevention, pre-hospital emergency medical
care, acute care hospitalization, and subsequent rehabilitation. EMS system is one of the important
parts in the inclusive trauma care system. In Korea, EMS system have been developed as an
important part for system of trauma care. Proper medical directorship, continuing effort for quality
improvement have been integral part for pre-hospital trauma care improvement in Korea.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
50
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1999-2008 Research Fellow in Nagoya University Graduate School of Medicine
2010 The Degree of “Doctor of Medical Science (PhD)” was Awarded
from Teikyo University
2011-Present Associate Professor in Trauma and Resuscitation Center
Department of Emergency Medicine, Teikyo University
2009-2011 Assistant Professor in Trauma and Resuscitation Center
Department of Emergency Medicine, Teikyo University
2000 Board Certificate Member of the Japanese Association of Acute
Medicine (Present; Senior Fellow of he Japanese Association of
Acute Medicine)
2008 Board Certification Member in the Japanese Organization of Cancer
Therapy
2013-Present Active Member - International Surgical Society ( ISS/SIC)
2013-Present General Secretariat of in International Association of Trauma and
Intensive Care(IATSIC) - Japan chapter in International Surgical
Society ( ISS/SIC)
Course Coordinator International Association of Trauma and
Intensive Care(IATSIC)
Education
Professional
Training and
Employment
Licensure and
Certification
Profesessional
Activity
Japan-Korean Symposium 1- Trauma System
Takashi Fujita (Chairman, Committee on International Liaison, JAST Associate Professor, Trauma and Resuscitation Center, Teikyo Univ.)
51
Japan-Korean Symposium 1 - Trauma System
In Hospital Trauma Patients
Management in Japan
Takashi Fujita (Chairman, Committee on International Liaison, JAST Associate Professor, Trauma and Resuscitation Center, Teikyo Univ.)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Medical College, Yonsei University (MB)
Graduate School of Medicine, Seoul National University (ABD)
Life Member of The Korean Society of Traumatology
Life Member of The Korean Society for Thoracic & Cardiovascular Surgery
2003.03 - 2011.02 : Assistant Professor, Department of Thoracic & Cardiovascular
Surgery (Konyang Univesity Hospital, Daejeon, Korea)
2011.03 - 2013.11 : Associate Professor, Department of Thoracic & Cardiovascular
Surgery (Konyang Univesity Hospital, Daejeon, Korea)
2013.12 - 2014.04 : Associate Professor
2014.04 - Present : Fund Professor
2015.03 - Present : Director of Trauma Center, Pusan National University Hospital,
Busan, Korea
2013.06 - Present : Secretary general, The 2nd & 3rd PPTC
2014.03 - Present : Councilor of KARPET(Korean Association of Research, Procedure
and Education on Trauma) Faculty of ESPIT(Essential Surgical
Procedures In Trauma)
2014.09 - Present : Director of BESPIT
Academic
Background
Work
Experience
Japan-Korean Symposium 1- Trauma System
Hyun-min Cho (Pusan National Univ. Hospital)
53
Japan-Korean Symposium 1 - Trauma System
In Hospital Trauma Patients Patients
Management in Korea
Hyun-min Cho (Pusan National Univ. Hospital)
Trauma is a leading cause of deaths for the working age population under 44 years old and a
source of expensive socioeconomic losses in Korea. Moreover, the preventable trauma death rate
in Korea is still higher than in developed countries. Korean government has been making a major
effort to establish a trauma system since 2000, but inadequacies of the current trauma system still
result in many preventable deaths from accidental injuries. For this reason, national support for
the establishment of regional trauma centers was launched in 2012 by the Ministry of Health and
Welfare. The purpose of this project is to designate 17 regional trauma centers distributed evenly
across the country and provide adequate care for seriously injured patients 24 hours a day, 7 days
a week. At present, 16 regional trauma centers have been designated and 9 of them have officially
opened.
In PNUH trauma center, all trauma patients admitted to the hospital were more than 2,500 and
900(36%) of them were severe trauma patients. The proportion of severe trauma patients (ISS >
15) directly transferred to TER (trauma center emergency room) was 74% (662). In spite of field
triage system, many severely injured patients (238, 26%) were transferred to ER (emergency center
emergency room). The results of treatment for severe trauma patients were ICU (416, 46.2%),
operation room (369, 41%), general ward (72, 8%), death (23, 2.6%) and transfer (20, 2.2%). The
proportion of LOS (length of stay) less than 3 hours of TER and ER was 78%, however, that of TER
only was 89%. Furthermore, indices of preventable trauma death rate (O:E ratio and W-score) were
dramatically improved after opening of regional trauma center.
Regional trauma centers must play a key role in a regionally inclusive trauma system that
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The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
integrates emergency medical systems and healthcare delivery systems to deliver optimal medical
care for injured patients. If the project is completed as planned, the quality of trauma care
(prehospital, transport, and hospital) will be high, and the lives of seriously injured patients can
more often be saved and their disabilities minimized.
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Gil Joon Suh (Seoul National Univ. Hospital)
Moderator
Yoshinori Murao (Kindai Univ.)
Chae-Hyuk Lee (COL, First ROK Army)
1F. Main Auditorium
Japan-Korean Symposium 2
Surgery and ICU Carein Polytrauma Patients
06-23 (Fri.), 2017
56
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1995 Graduated from Hokkaido University, Medical School
National Board of Medicine,
Japanese Board of Surgery
Japanese Board of Emergency Medicine
1995-1999 Kobe City General Hospital, as a Surgical Resident
1999-2002 Senshu Critical Care Medical Canter
2002-2010 Hokkaido University Hospital and Group Hospitals
2010-2014 Hyogo Emergency Medical Center
2014-2015 Sakai City Hospital
2015- Sakai City Medical Center
Education
Licensure and
Certification
Work Expeience
Japan-Korean Symposium 2 - Surgery and ICU Care in Polytrauma Patients
Akihiro Usui (Sakai Municipal Hospital)
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Japan-Korean Symposium 2 - Surgery and ICU Care in Polytrauma Patients
Our “Acute Care Surgery” System in Japan:
an Experience from a Regional Hospital
Akihiro Usui (Sakai Municipal Hospital)
Traffic and industrial accidents are decreasing in Japan. Accordingly, surgical trauma cases are
declining. So those experiences are not enough for Japanese “ trauma surgeon”, especially for
surgical trainees.
The concept of “Acute Care Surgery”, which contains “trauma surgery”, “emergency general
surgery” and “critical care”, is spreading from the United States. I am willing to accept that idea, but
I would like to add three points in surgical area;
1. dealing with trauma patients constantly
2. doing emergency general surgery vigorously
3. also participating in elective surgical cases
Sakai City Medical Center is a 500-bed acute-care hospital opened in July, 2015. And our
emergency medical center is covering a medical area where 90 million people live. We serve as a
regional emergency medical center, which has 4089 trauma visits and 1728 admission a year.
It goes without saying that an exposure to trauma cases is very important. But our surgical
cases on trauma are only 90 cases a year. I think these are so small that every surgeon cannot keep
or develop his surgical skills. We also take care of patients who need emergency general surgery.
Those number are more than 350 cases a day. Through both surgical fields, we can maintain our
skill and motivation.
Surgical technique and its technology are evolving everyday. We have to keep up with those.
So I think it necessary to do electives. Our member is to rotate other surgical subspecialities. So
we can adapt current techniques (ex. endoscopic surgery) in emergency cases and keep good
relationship with other surgical colleagues.
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The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Ph.D. Chonnam National University
M.D. Chonnam National University
Residentship, Department of General Surgery, Chonnam National University Hospital
Director of Division of Trauma Surgery, Chonnam National University Hospital
Director of Education, Trauma Center, Pusan National University Hospital
現) Director of TICU3, Trauma center, Pusan National University Hospital
現) Assistant Professor, Pusan National University
現) JAST member
現) JSACS member
現) Director of Trauma Education, SECCI
現) Director of General Affair, KARPET
現) Director of Education, KST
現) Associate Editor, Trauma Image and Procedure (TIP), KARPET
Education
Professional
Experience
Medical Committee
Membership
Japan-Korean Symposium 2 - Surgery and ICU Care in Polytrauma Patients
Chan Yong Park (Pusan National Univ. Hospital)
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Japan-Korean Symposium 2 - Surgery and ICU Care in Polytrauma Patients
Operative Management in Polytrauma
Patients in Korea
Chan Yong Park (Pusan National Univ. Hospital)
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The 32nd Annual Meeting of the Korean Society of Traumatology
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The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
March 2001: M.D., Toyama university
Received a Medical License No. 420057 in May 2001
March 2017: Ph.D. in Medicine, University of Tsukuba
March 2017: M.P.H., University of Tsukuba
April. 2006-
Assistant Professor : Department of Emergency and Critical Care Medicine
Chiba-Hokusoh Hospital, Nippon Medical School
June. 2017-
Visitting Reseacher : Facalty of Medicine, University of Tsukuba Clinical Trial and
Clinical Epidemiology
European Society for Intensive Care Medicine
Japanese Society of Anesthesiologist
Japanese Association for Acute Medicine
The Japanese Society of Intensive Care Medicine
Japan Society of Respiratory Care Medicine
The Japanese Association for the Surgery of Trauma
73th Annual Congress of American Association Surgery for Trauma International Report
Award
Education
Academic
Appointments
Activities of
Professional
Societies
Award
Japan-Korean Symposium 2 - Surgery and ICU Care in Polytrauma Patients
Nobuyuki Saito Nippon (Medical Univ. Chiba Hokuso Hospital)
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Japan-Korean Symposium 2 - Surgery and ICU Care in Polytrauma Patients
Postoperative Management in Polytrauma
Patients in Japan
Nobuyuki Saito Nippon (Medical Univ. Chiba Hokuso Hospital)
Blunt trauma, which is accounts for the majority of injuries in Japan, is not a “single disease”
because it involves multiple sites. Perioperative management is very important for improving
the survival rate in polytrauma patients who need emergency surgery. Although the location
of treatment moves from the emergency department (ED) to operating theater and intensive
care unit (ICU), the concept of perioperative management is consistent, and involves sequential
resuscitation. The underlying principle of its management is to grasp the pathophysiology
peculiar to trauma and combine tactics adapted to each treatment stage. Organ dysfunction may
occur from the moment of injury until the start of treatment. The most feared complication of
polytrauma is systemic circulatory failure due to hemorrhagic shock. Damage control resuscitation
including urgent surgical hemostasis and massive transfusion (MT) may help solve this problem.
After surviving the shock period, we must prevent acute lung injury associated with MT and
other complications, including sepsis, and venous thrombosis. If the patient does not recover
from the shock state after hemostasis in the ICU, a trauma team including surgeons, intensivists,
nurses, and paramedics must estimate the cause of shock from a multidisciplinary approach.
Unfortunately, even if careful evaluation is done in the ED, missed injuries often happen because
of nonspecific findings due to unconsciousness and shock. Thus, appropriate information sharing
and communication in the team can help patients to recover. Recently, it is recommended to start
rehabilitation even from the acute phase to prevent post intensive care syndrome and to improve
functional outcome.
In this lecture, we refer to our recent findings on postoperative management after the aortic
occlusion method including resuscitative endovascular balloon occlusion of the aorta with attention
to western countries.
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
2002.2 : Master, Korea University of Graduate School (Medicine)
2005.2 : Doctor, Korea University of Graduate School (Medicine)
2016.2 ~ : Head of Critical Care Department at Korea University Guro Hospital
2016.7 ~ : Board Member of Korean Surgical Infection Society
2014.4 ~ 2014.5 : Trauma Surgeon, Agok MSF Trauma Hospital, South Sudan
2014.3 ~ : Manager of Trauma Surgery at Korea University Guro Hospital
2014.3 ~ : Board Member of MEDICINS SANS FRONTIERES KOREA
2013.6 ~ : Director, Korea Disaster Surgical Response Team
2014.3 ~ 2016.3 : Board Member of MEDICINS SANS FRONTIERES JAPAN
2013.3 ~ : Associate Professor of General Surgery at Korea University Guro Hospital
2011.10 ~ 2012.11 : Manager of Trauma surgery at Cheju Halla General Hospital
2011.1 ~ 2011.5 : Field Medical Doctor / Medical Consultant in MSF-CH Yanbian
2010.10 ~ 2010.11 : Trauma Surgeon, Hangu MSF Trauma Hospital, Pakistan
Education
Qualification &
Experience
Japan-Korean Symposium 2 - Surgery and ICU Care in Polytrauma Patients
Namyeol Kim (Korea Univ. Guro Hospital)
65
Japan-Korean Symposium 2 - Surgery and ICU Care in Polytrauma Patients
Postoperative Management in Polytrauma
Patients in Korea
Namyeol Kim (Korea Univ. Guro Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Namyeol Kim (Korea Univ. Hospital)
Moderator
Jae Baek Lee (Chonbuk National Univ. Hospital)
Hee-Jin Yang (Seoul National Univ. Boramae Hospital)
1F. Seminar 1
Training Course 2 (KR)
Management of Trauma Patients in ICU
06-23 (Fri.), 2017
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Yonsei University College of Medicine B.S. (Medicine)
Yonsei University Graduate School of Medicine M.S. (Medicine)
Yonsei University Graduate School of Medicine M.D. (Medicine)
2005. 3 ~ 2006. 2 Internship at Yonsei University’s Severance Hospital
2006. 3 ~ 2010. 2 Resident in Department of Internal Medicine at Yonsei University’s
Severance Hospital
2010. 3 ~ 2011. 2 Lecturer on Internal Medicine of Heart at Yonsei University’s
Severance Hospital
2011. 3 ~ 2013. 2 Clinic Assistant Professor of Internal Medicine of Heart at Yonsei
University’s Severance Hospital
2013. 3 ~ Head of Department of Internal Medicine of Heart Intensive Care
Unit at Yonsei Cardiovascular Hospital
Member of The Korean Association of Internal Medicine
Member of The Korean Society of Cardiology
Member of The Arrhythmia Research in Korean Society of Cardiology
Education
Experience
Society
Training Course 2 (KR) - Management of Trauma Patients in ICU
Jin Wi (Yonsei Univ. Hospital)
68
Training Course 2 (KR) - Management of Trauma Patients in ICU
Hemodynamic Monitoring of the
Injured Patient
Jin Wi (Yonsei Univ. Hospital)
Increasingly, echocardiography is being used to monitor hemodynamics and direct therapy in
critically ill patients. Case reports, observational studies, and state-of-the-art literature reviews have
demonstrated the potential role of echocardiography in care and decision making for medical
and surgical patients. Intensivists, trauma physicians, cardiologists, and anesthesiologists are now
using echocardiography to provide hemodynamic assessments in patients with life-threatening
illnesses such as sepsis, respiratory failure, congestive heart failure (CHF), shock, and traumatic
injuries, as well as patients with significant respiratory and cardiac diseases undergoing noncardiac
surgery and high-risk noncardiac procedures. The clinical impact on diagnosis, decision making,
and management has led governing bodies to address the potential value of echocardiography
in unstable medical and noncardiac surgical patients. The recent consensus statement and the
standardization of the basic perioperative transesophageal echocardiographic examination have
led to the need for guidelines regarding when, and how, to use echocardiography as a quantitative
monitoring tool. Echocardiography is being used as a monitoring tool if, after a diagnostic
assessment, repetitive hemodynamic or anatomic assessments are being made over a period of
minutes, hours, or days in the same patient to guide management.
Echocardiography has the ability to noninvasively evaluate and track both RV and LV
hemodynamic status. Echocardiography can be used to manage the response to fluid resuscitation
in critically ill patients who are at risk for shock or tissue hypoperfusion. Traditional monitors, such
as central venous catheters or pulmonary artery (PA) catheters, have not been found to improve
survival or decrease length of stay in hospitalized patients. PA catheters, when used to estimate
left atrial (LA) pressure (LAP), can cause PA rupture. They are typically calibrated with saline-filled
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The 32nd Annual Meeting of the Korean Society of Traumatology
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The 32nd Annual Meeting of the Korean Society of Traumatology
transducers at the bedside and therefore can be inaccurate in the assessment of LV filling pressures
because of waveform artifacts, damping, and airway pressure, especially in ventilated patients.
Furthermore, PA catheters and central venous catheters do not accurately measure LV diastolic
dysfunction, which is more predictive of mortality in hospitalized patients. Echocardiography has
the potential to noninvasively measure left-sided filling pressures and guide volume assessments
in hospitalized patients who may be at risk for both systolic and diastolic heart failure. Serial
examination of two dimensional (2D) and Doppler indices can be used to monitor stroke
volume (SV) and overall volume status. Several studies have recently shown the benefits of goal-
directed fluid therapy in surgical patients. In this setting, 2D echocardiography with Doppler can
measure changes in SV in response to either a fluid bolus or the administration of a diuretic, while
monitoring LAP with transmitral and tissue Doppler imaging (TDI) as well as right atrial pressure
(RAP) using vena cava respiratory dynamics. The limitation of echocardiography in this setting
is that it cannot perform continuous monitoring, and it requires meticulous attention to sample
volume placement. In this lecture, I will discuss about all areas in which echocardiography is
monitoring a therapeutic guidance, whether it is fluid resuscitation, pericardial effusion monitoring,
or during perioperative care in the injured patients.
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
2002.3 - 2007.2 Ph.D. in Medical Science
Graduate School of Korea University, Seoul, Republic of Korea
[Ph.D. Thesis]
The Flow of Non-Pulsatile Pump to Maintain an Equal Coronary Flow on
Ibrillating Heart by Pulsatile Pump. (Director: Prof. Kyung Sun)
2013.3.1~3.31 ECMO and Cardiac Surgery Training
Regensburg University Hospital, Regensburg, Germany
2013.4.1~4.14 Minimal Invasive Surgery and TAVI Training
Leipzig University Heart Center, Leipzig, Germany
2013.5.27~5.31 Clinical and Research Training in ECMO
Michigan University ECMO Center, Ann arbor, USA
2015. 3 - present Associate Professor,
Dept. of Thoracic and Cardiovascular Surgery
Advisor of Organ Transplantation Center,
Anam Hospital, Korea University Medical Center, Seoul, Republic
of Korea
Education
List of Training
Employments
Training Course 2 (KR) - Management of Trauma Patients in ICU
Jae-Seung Jung (Korea Univ. Hospital)
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Training Course 2 (KR) - Management of Trauma Patients in ICU
Massive Pulmonary Embolism:
Lyse, Suction or Operate?
Jae-Seung Jung (Korea Univ. Hospital)
The majority (70%) of patients with acute PE are normotensive and have normal RV function.
Prognosis is excellent in this subgroup when treated with anticoagulation alone. Patients with PE
and normal blood pressure, but who have evidence of RV dysfunction, are categorized as having
submassive PE. Submassive PE accounts for one quarter of all cases of acute PE and is associated
with an increased risk of adverse outcomes and early mortality.1 Patients with acute PE, sustained
hypotension, cardiogenic shock, syncope, respiratory failure, or cardiac arrest are classified as hav-
ing massive PE and have the highest risk of mortality.2 Though massive PE is less common (5% of
PE cases), patients with PE and hemodynamic instability have significantly higher death rates (58%)
than stable patients and warrant advanced therapy.3
Acute massive pulmonary embolism(AMPE) is life-threatening. Despite advances in diagnosis
and therapy, AMPE is still associated with exceptionally high mortality and morbidity rates. Patients
presenting with AMPE are at high risk of circulatory collapse, medical and mechanical reanimation
and late pulmonary hypertension. Prompt treatment should be undertaken when dealing with
AMPE. However, optimal management remains debated, and there is no consensus regarding the
best therapeutic method. Although in recent studies the results of surgical embolectomy have been
satisfying, current guidelines suggest thrombolytic therapy as the treatment of choice. Therefore
surgical management is placed in reserve for critically ill and high-risk patients, in whom thrombol-
ysis is absolutely contraindicated or has failed.4
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The 32nd Annual Meeting of the Korean Society of Traumatology
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The 32nd Annual Meeting of the Korean Society of Traumatology
Lyse (Systemic Fibrinolysis)
If no contraindications exist and the patient has a low risk of bleeding, systemic fibrinolysis may
be considered for patients with massive PE or a subset of patients with submassive PE. Systemic
thrombolysis is the standard therapy for acute massive PE; however, systemic thrombolysis carries
an estimated 20% risk of major hemorrhage, including a 3% to 5% risk of hemorrhagic stroke. Es-
pecially, patients who underwent SE after thrombolytic therapy failure clearly demonstrate a crit-
ically high mortality rate. It is suggested that surgical embolectomy should not be delayed for the
critically ill patients with AMPE
Suction (Catheter-directed therapy)
The potential for lower bleeding risk is catheter-assisted “pharmacomechanical” therapy. Cathe-
ter-assisted embolectomy is a technique that combines low-dose “local” fibrinolysis and mechanical
thrombus manipulation. One strategy, ultrasound-facilitated, catheter-directed, low-dose fibrinoly-
sis requires only a fraction of the systemic fibrinolytic dose and rapidly improves RV function while
minimizing the risk of intracranial hemorrhage. The subsequent U.S.-based Submassive and Mas-
sive Pulmonary
Embolism Treatment with Ultrasound Accelerated Thrombolysis Therapy (SEATTLE II) trial as-
sessed the use of catheter-based lowdose fibrinolysis for 150 patients with submassive(79%) and
massive PE(21%). The RV/LV diameter ratio was reduced by 25% from baseline to 48 hour after
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The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
start of the procedure. Both mean pulmonary artery systolic pressure and Modified Miller Index
(measure of angiographic obstruction) were reduced by 30% from baseline to follow-up at 48
hours. There was no difference in response between submassive and massive PE patients. Major
bleeding occurred in.
10% of the patients. No patient suffered intracranial hemorrhage. Based on these data, the FDA
approved ultrasound-facilitated, catheter-directed, low-dose fibrinolysis with the EkoSonic Endo-
vascular System for treatment of PE on May 21, 2014.
Operate (Surgical pulmonary embolectomy)
Surgical pulmonary embolectomy achieves best results in patients with large, centrally located
thrombi. The procedure requires a median sternotomy and cardiopulmonary bypass and can be
performed expeditiously with low operative mortality in experienced hands. In patients with sub-
massive PE, surgical pulmonary embolectomy is considered when patients are not eligible for cath-
eterdirected therapy, systemic fibrinolysis is contraindicated or has failed and in patients who have
thrombus in the right atrium or ventricle (clot-in-transit).
1. Piazza G, Goldhaber SZ. Management of submassive pulmonary embolism. Circulation. 2010;
122: 1124-1129.
2. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the
International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999; 353: 1386-
1389.
3. Agnelli G, Becattini C. Acute pulmonary embolism. N Engl J Med. 2010; 363: 266-274.
4. Fukuda I, Taniguchi S, Fukui K, Minakawa M, Daitoku K, Suzuki Y. Improved outcome of
surgical pulmonary embolectomy by aggressive intervention for critically ill patients. Ann
Thorac Surg. 2011; 91(3): 728e732.
5. Wadhera RK, Piazza G. Treatment options in massive and submassive pulmonary embolism.
Cardiology in Review 2016; 24: 19-25).
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Bachelor of Medicine, Kyunghee University (2004)
Master of Medicine, Gachon University of Graduate School (2008)
Doctor of Medicine, Gachon University of graduate School (2015)
Internship, Resident in Department of Surgery at Gachon University Gil Medicine
Center (2004~2009)
Army Surgeon (27th Division of Medical Corps, the Service Support Group) (2009~2012)
Trauma Surgeon at Gachon University Gil Medicine Center (2012~2013)
Clinic Assistant Professor of Trauma Surgeon at Gachon University Gil Medicine Center
(2014~2015)
Assistant Professor of Traumatology at Gachon University of Medicine (2016~ )
Medical Doctor's License (2004)
Surgery Specialist (2009)
Traumatic Surgical Specialist (2014)
Critical Care Specialist (2015)
Education
Experience
License
Training Course 2 (KR) - Management of Trauma Patients in ICU
Giljae Lee (Gachon Univ. Gil Hospital)
75
Training Course 2 (KR) - Management of Trauma Patients in ICU
Necrotizing Soft Tissue Infection
Giljae Lee (Gachon Univ. Gil Hospital)
Necrotizing soft tissue infections (NSTI) are rare and life-threatening bacterial infections charac-
terized by the rapid progression of infection in any layer of the skin and soft tissue, resulting in ex-
tensive tissue necrosis. NSTI represents high rates of morbidity and mortality, and impaired quality
of life among the survivors.
NSTI can affect any part of the body but the extremities particularly of lower limbs are most
commonly involved. The infection may be monomicrobial with group A streptococcus and Staph-
ylococcus aureus being the most frequently isolated pathogens. However in most cases, the infec-
tion is polymicrobial, involving gram-positive cocci, Enterobacteriaceae, nonfermenting bacilli as
well as anaerobic bacteria.
The management of NSTI includes rapid surgical debridement and broad-spectrum antibiotics,
and intensive care. Early diagnosis allowing for early surgical debridement improves survival.
However, diagnosis at the initial disease stage is difficult and NSTI may be misdiagnosed in more
than half of patients.
Source control of infection is paramount and serial surgical debridements are generally required.
The frequency and number of required debridements varies based on aggressiveness of infection,
but generally patients should return to the operating room for debridement every 24-48 h until
there is no evidence of continued or progressive skin and soft tissue necrosis. Wound dressing
changes should be carried out at least daily to look for evidence of ongoing infection that would
require repeat debridement. In addition to wound appearance, clinical deterioration as measured
by increased requirements for intensive care support or laboratory parameters suggestive of wors-
ening infection should prompt discussion of repeat debridement.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1997 - 2003 Ajou University of Medicine
2007 - 2009 Ulsan University of Graduate School of Medicine
2009 - 2011 Ajou University of Graduate School ofMedicine
2013 .03 ~ 2016 .02
Ajou University Hospital / Surgery /Assistant Professor, Head of Surgery Intensive
Care Dept
2017.1.1. ~
Korea University Anam Hospital / Surgery / Clinic Assistant Professor
Korean Medical License / 2003.03 / Ministry of Health and Welfare
Surgical Specialist / 2008.03 / Ministry of Health and Welfare
Critical Care Medicine Specialist / 2011.06 / Ministry of Health and Welfare
Education
Experience
License
Training Course 2 (KR) - Management of Trauma Patients in ICU
Jae-Myeong Lee (Korea Univ. Hospital)
77
Training Course 2 (KR) - Management of Trauma Patients in ICU
Update of New SCCM/ASPEN Critical Care
Nutrition Guideline
Jae-Myeong Lee (Korea Univ. Hospital)
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Hong-Chul Lim (Seoul Barunsesang Hospital)
Moderator
Hong-Chul Lim (Seoul Barunsesang Hospital)
1F. Seminar 1
Special Lecture
Diaster
06-23 (Fri.), 2017
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
· Graduated from Yonsei University College of Medicine
· Internship and Residency at Severance Hospital, Yonsei Medical Center
· Board certified in Cardiovascular and Thoracic Surgery
· Medical Research Fellowship at Walter Reed U.S. Army Institute of Research, Division of Trauma
Resuscitation
· Board certified in Trauma Surgery
· Director of Dept. of Clinical Support Services, Armed Forces Health Services School
· Director of Clinical Services, Armed Forces Capital and Chung-Pyung Hospital
· CO, Armed Forces Ildong, Wonju, Chung-pyung, and Yangju Hopital.
Special Lecture - Diaster
Chae-Hyuk Lee (COL, First ROK Army)
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Special Lecture - Diaster
Trauma Management in Nuclear Warfare
Chae-Hyuk Lee (COL, First ROK Army)
Besides the magnitude of the potential damage, radiological and nuclear warfare may pose a
unique set of problems. Radiation dispersal devices or radiation exposure devices are expected
to produce minimal, if any, conventional trauma victims, among the survivors. But in case of a
nuclear detonation, conventional physical trauma, due mostly to blast wave and wind, burns and
ionizing radiation exposure will occur in combination mostly and separately. The relative extents
of respective damage wound depend on the size of the nuclear weapon.
A nuclear weapon, upon detonation will distribute its energy in forms of blast and shock (50%),
thermal radiation (35%), and nuclear radiation (15%). Thus the blast and thermal effects of detona-
tion would produce by far the greatest number of immediate human casualties, and superimposed
exposure to ionizing radiation complicates the problem even further. Essentially the effect of ion-
izing radiation is apoptosis and failure to regenerate and repopulate the damaged cells, and would
produce Acute Radiation Syndromes (ARS), namely in increasing order of exposure dose, hemato-
poietic, intestinal and neurovascular syndrome.
Casualties whose radiation doses are most amenable to medical treatment will be those who
receive between 2 to 6 Gy. For these casualties, if they also have burns or trauma, cytokine and
antibiotic therapy are warranted. Many casualties whose doses exceed 6 to 8 Gy will probably also
have significant blast and thermal injuries that will preclude survival when combined with radiation
insult. In case of coexisting trauma in a radiation exposed victim, wound closure should be per-
formed within 24 to 36 hours.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Yong-Cheol Yoon (Gachon Univ. Gil Hospital)
Moderator
Beom Koo Lee (Armed Force Capital Hospital)
Kichul Park (Hanyang Univ. Hospital )
1F. Seminar 1
Symposium 1
Treatment of Vulnerable Orthopedic Trauma Patients
06-23 (Fri.), 2017
88
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1998-2004 Medical Doctor Gachon Medical School, Inchoen, Korea
2004-2009 Resident Gachon University Gil Medical Center
2009-2012 Chief of General Surgery Department Armed Forced Wonju Hospital
2012-2014 Fellowship of Trauma Surgery Gachon University Gil Medical Center
2016- Assistant Professor Gachon University Gil Medical Center
Education
Professional
Positions
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Byungchul Yu (Gachon Univ. Gil Hospital)
89
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Physiological Changes of Elderly
Trauma Patients
Byungchul Yu (Gachon Univ. Gil Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
March 2008 - February 2010 Ewha Univ. Mok-Dong Hospital (Fellowship)
March 2010 - August 2013 The Graduate School, Yonsei University Degree of Doctor
of Philosophy
August 2013 - July 2014 Clinical Fellowship in Level 1 Trauma Center, Hannover
Medical School, Germany
National Faculty of AO Ttauma
Editorial Board member of Journal of the Korean Orthopaedic Association
Editorial Board member of the Journal of the Korean Fracture Society
Editorial Board member of the Journal Minimally Invasive Ortopedics
Education
Main Professional
Memberships
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Hoon-Sang Sohn (National Medical Center)
91
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Orthopedic Trauma Treatment of
Elderly Patients
Hoon-Sang Sohn (National Medical Center)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
July, 2017 : AOTrauma Visit-the-Expert Fellowship, Regions Hospital, St. Paul,
Minnesota, USA (Under the Mentoring of Prof. Peter Cole)
Nov., 2013 ~ Dec., 2013: AOTrauma fellowship, Kantonsspital, Luzerne, Switzerland
(Under the Mentoring of Prof. Dr. med. Reto Babst)
Mar., 2016 ~ : Assistant Professor, Kyungpook National University, School of Medicine
Division of Musculoskeletal Trauma
Department of Orthopaedic Surgery & Regional Trauma Center
Mar., 2012 ~ Feb., 2016 : Instructor, Clinical professor, Kyungpook National University
Hospital
Department of Orthopaedic Surgery & Regional Trauma Center
Operation Committee Member of Regional Trauma Center
The License of Korean Board of Trauma Surgery (Feb. 2015, No. 2015-39)
Journal of Trauma and Injury
Education and
Training
Appointment
Licenses
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Joon-Woo Kim (Kyungpook Univ. Hospital)
93
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Orthopedic Trauma Treatment of
Pediatric Patients
Joon-Woo Kim (Kyungpook Univ. Hospital)
For the treatment of multiple fracture or trauma in children, pediatric-related anatomy and
pathophysiology should be well understood. Multidisciplinary approach of the pediatric specialists,
such as a pediatrician, pediatric trauma surgeon, pediatric intensive care physician, is requisite for
initial assessment, procedure and resuscitation.
The severity of head injury is a major determinant of the prognosis and the mortality rate. The
operation of abdominal injuries is rarely needed compared with adults, but evaluation and discov-
ery is essential. Spinal and pelvic injuries, as well as limb fractures, require age-appropriate surgical
treatment.
Although children sustain very severe, multiple injury, they often show markedly excellent
recovery. Therefore, the best treatment should be provided all the time on the assumption that
complete recovery is achieved. Despite pediatric patients with large numbers of multiple injuries
survive, they often have long-term complications. The main reasons for having functional defects
are damage to the central nervous system and musculoskeletal system. In pediatric patients with
multiple injuries, orthopedic treatment is crucial to minimize future disability.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
2003 National Board of Medical Doctors
2008 Board of Orthopaedic Surgery
2011 Department of Orthopaedic Surgery Clinical Fellow
Gangnam Severance Hospital Division of Traumatology
(Prof, Kyu Hyun, Yang)
Education
Professional
Training
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Hyung-Keun Song (Ajou Univ. Hospital)
95
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Painful Memory Case I
Hyung-Keun Song (Ajou Univ. Hospital)
A 85-year-old woman had an open pelvic fracture as a result of a high energy pedestrian traffic
accident with direct trauma against the bus bumper. She arrived at our trauma bay in a state of
shock (blood pressure 70/30mmHg and heart rate of 120 beats/min). She was managed according
to the ATLS protocol with aggressive resuscitation. Chest radiograph and FAST were unremarkable,
while the pelvic radiograph showed an unstable open book pelvic fracture. Initial surgical manage-
ment included irrigation and debridement of the pelvic and vaginal wound, ligation of Right obtu-
rator artery and branch of internal iliac artery, pelvic packing, external fixation of pelvis. She was
admitted to intensive care department in a hemodynamically stable condition with blood pressure
of 110/69 mm. Other injuries sustained included a left ankle bimalleolar fracture, right ankle medial
malleolar fracture and Left acetabular transverse fracture. The ISS was calculated to be 36. After
two days, definitive stabilization of pelvic fracture was performed with anterior plate fixation of the
symphysis and pubic fractures and external fixator was removed. After 2 weeks, we found that the
anterior pelvic plate and screw was loosening and her wound was infected.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1999. 03 - Pusan National University of Medicine
2014. 3 ~ 2015. 2: Orthopedist, Professor of Trauma Center at Pusan National
University Hospital (Traumatology)
2015. 3 ~ present: Clinic Assistant Professor of Orthopedic and Trauma Center at
Pusan National University Hospital (Traumatology)
Education
Experience
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Jae-Hoon Jang (Pusan National Univ. Hospital)
97
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Painful Memory Case II
Jae-Hoon Jang (Pusan National Univ. Hospital)
Objective
To review the case which was challenging to manage and gave a painful memory to surgeon.
Methods
Eldery patient who had polytrauma including pelvic ring injury. (ISS=29)
ORIF for pelvic ring injury was performed.
Results
During followup, fixation failure and reduction loss was occurred.
Furthermore, neglected fracture was observed.
Conclusion
When treating eldery patients, it needs more cautious approaches and choices of treamtnet.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Medical doctor of Medical School, graduated February, 2005
- Inje University, Busan, Korea
Interns : March, 2005 ~ February, 2006
- Inje University Seoul Paik Hospital, Seoul, Korea
Resident : March, 2006 ~ February, 2010
- Department of Orthopedic Surgery, Seoul, Korea
- Inje University Seoul Paik Hospital
Army doctor (Captain) : March, 2010 ~ April, 2013
- Armed Forces Capital Hospital
Fellowship : May, 2013 ~ February, 2016
- Korea University Guro Hospital (May, 2013 ~ April, 2014)
- Inje University Ilsan Paik Hospital (May, 2014 ~ February, 2015)
- Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
(March, 2015 ~ February, 2016)
Clinical Assitant Professor : March, 2016 ~ Now
- Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
Medical License, Ministry of Health and Welfare, Korea - February, 2005
Board of Orthopedic Surgery, Ministry of Health and Welfare, Korea - March, 2010
Subspecial board of Trauma Surgery, The Korean Society of Traumatology - February, 2015
2nd AOT AP Scientific Congress & TK Experts' Symposium - May, 2014
- Awarded The Young Investigator
Education
Experience
Certificate
Achievement
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Youngwoo Kim (The Catholic Univ. Hospital)
99
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Painful Memory Case III
Youngwoo Kim (The Catholic Univ. Hospital)
I tried to look into the management for orthopedic trauma patients with pregnancy through my
painful memory cases.
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The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Mar. 2005-Feb. 2011 Kosin University School of Medicine (M.D)
Sep. 2014-Jul.2016 Korea University School of Medicine (Master)
Mar. 2012-Feb. 2016 Resident, Department of Orthopaedic Surgery, VHS
Medical center, Seoul, Korea
Mar. 2016- present Clinical Instructor, Trauma Division, Department of
Orthopaedic Surgery, Korea University College of Medicine
2017.3 - ESPIT
2017.3 - AO Trauma Symposium - Foot & Ankle
2017.4. - AO Trauma Europe Masters Course - Osteotomy in Posttraumatic Deformity
- Lower Extremity
2017.5 - Korean-Japanese Combined Orthopaedic Symposium
Education
Professional
Training and
Employment
Lisensure and
Certification
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Jin-Kak Kim (Korea Univ. Hospital)
101
Symposium 1 - Treatment of Vulnerable Orthopedic Trauma Patients
Painful Memory Case IV
Jin-Kak Kim (Korea Univ. Hospital)
Fracture of Osteoporotic Bone like a sponge, How to reduce it?
Fractures in the elderly are still increasing and are almost always associated with osteoporosis.
Osteoporotic bone, structurally altered because of reduction of bone mineral density and quality
deterioration, can easily head for fracture after minimum mechanical stress. Treatment of fracture
with severe osteoporotic bone is one of the toughest problems we can stuck with. Because the
bone quality is too poor to maintain reduction of fracture. Osteoporosis at the site of fractures may
lead to unsatisfactory results due to inadequate operation. Today I’d like to talk about my painful
memory of osteoporotic bone fracture. And we will discuss about reduction technique of osteopo-
rotic bone.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Seon Hee Kim (Pusan National Univ. Hospital)
Moderator
Kun Hwang (Inha Univ. Hospital)
Seogki Lee (Chosun Univ. Hospital)
1F. Seminar 1
Symposium 3
Trauma in Special Population
06-23 (Fri.), 2017
103
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1985-1992: School of Medicine, Seoul National University
2012: Ph.D Depart. of Surgery, School of Medicine, Seoul National University
1995-1996: Intern, Seoul National University Hospital
1996-2000: Resident, Depart. of Surgery, Seoul National University Hospital
2000-2001: Fellowship Division of HepatobiliaryPancreas Surgery and Liver
Transplantation, Depart. of Surgery, Seoul National University Hospital
- 2015 : Associate Prof. Department of Surgery Eulji University
Present : Director of Regional Trauma Center, Cheju Halla General Hospital Jeju
Member of Korean Surgical Society
Member of Korean Association of HBP Surgery
Member of The Korean Society of Traumatology
Director, External Affair Coordination Committee, The Korean Society of Traumatology
Education &
Training
Employment
Professional
Association
Symposium 3 - Trauma in Special Population
Min Koo Lee (Jeju Halla Hospital)
104
Symposium 3 - Trauma in Special Population
Pediatric Trauma
Min Koo Lee (Jeju Halla Hospital)
I. intrududction
Trauma leading cause of death > 1 year
65% of deaths due to unintentional injury
II. Unique Problems in the Pediatric Population
- High Surface Area/Body Volume = Greater Heat Loss
- Less calcified therefore more flexible ->Greater incidence of abdominal, chest and spinal cord
injury without fracture
III. Specific injury
1. CNS
- CNS injury is the leading cause of death among injured children
- Physiologic reserve of the child: recover more frequently and more fully than similarly injured
adults
- Children tend to sustain injuries that produce diffuse edema rather than those that cause focal
space-occupying lesions
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
2. Spinal Cord Injury
- Spinal cord injury without radiologic abnormality (SCIWORA) syndrome is a problem unique
to the pediatric population
- Radiologic evaluation should consider normal variants, such as C2-C3 pseudosubluxation oc-
curring in 9% of children up to age 7 years
3. Thoracic Injuries
- Thoracic injury occurs in about 5% of children
- Isolated thoracic injuries seen commonly in adults are relatively uncommon in children
- Due to the pliability of the pediatric rib cage and mediastinal mobility, significant intrathoracic
injury may exist in the absence of external signs of trauma
- Over half of rib fractures in children younger than 3 years may be due to child abuse
- Traumatic diaphragmatic rupture occurs in about 1% of children with blunt chest trauma, with
left-sided rupture being more common
4. Small Intestinal Injury
- The most common intra-abdominal organs injured in restrained children involved in MVAs are
hollow viscus type
- The most common site of the intestinal tract to be injured is the jejunum in the area of the Tre-
itz ligament. Such injury occurs in association with lap seat belt use or rapid deceleration. Up
to 50% of children with lap seat belt injuries have associated retroperitoneal injuries
5. Spleen injury
- Because of the risk of overwhelming sepsis following splenectomy (OPSS), the current philos-
ophy is to manage splenic injuries conservatively unless the spleen is hemodynamically com-
promised
6. Hepatic Injury
- The success rate for nonoperative management of blunt hepatic injury is about 85-90%.
- Hemodynamic instability should prompt surgical treatment; however, a role for angiographic
embolization may exist
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The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
7. Pancreatic Injury
- A frequently mechanism involves falling into bicycle handlebars
- Timely diagnosis of major pancreatic injuries and prompt surgical treatment are essential to de-
crease mortality and morbidity rates in pediatric patients
8. Vascular Injuries
- Most vascular injury is associated with orthopedic injuries, such as supracondylar fracture or
long-bone fracture
- The most important differential diagnosis in pediatric vascular trauma is between thrombosis
and spasm of the injured vessel. Spasm usually lasts less than 3 hours. When the pulses re-
main absent longer than 6 hours, thrombosis or transection of the vessel must be excluded
IV. Unique injury in pediatric population
1. Air Bag Injuries
- Most pediatric injuries are a result of proximity to air bag deployment and unused or improp-
erly used seat belts
- Can cause decapitation in young children, severe face, chest and abdominal injuries
- The safest place for a child is in the middle of the back seat, either in a safety seat or in a
3-point restraint
2.Child Abuse
- physical abuse, sexual abuse, emotional abuse, and child neglect
- maintain a high level of clinical awareness when evaluating these children
V. Initial management
1. Airway
- oral airway: DO NOT INSERT AND ROTATE 180 degrees
107
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
- Endotracheal Intubation: Broeslow Tape,Tube diameter should be the size of the child’s 5th
finger
- Failure of Intubation: Needle Cricothyroidotomy is best
2. Breathing
- Pneumothorax without fractures common
- 12-16 chest tube in a baby, 28-32 chest tube in a small teenager
- Pulmonary Contusion: Common in children after blunt chest injury, Often no associated rib
fractures
3. Circulation
- Estimated Blood Volume = 80cc/kg
- Fluid Bolus = 20cc/kg of crystalloid x 3
- Colloid/Blood Bolus = 10cc/kg
- Vascular Access: 2 attempts at percutaneous venous access, Interosseous infusion,. Saphenous
vein cutdown above the medial malleolus, Percutaneous femoral vein catheter, Internal Jugu-
lar catheter, Subclavian catheter
4. Disability
- Pediatric Glascow Coma Scale
5. Exposure
- Keep the child WARM!!!!
Baer Hugger
Heating Lamps (be careful of burning the skin!)
Wrap the extremities in wool cast padding
Each child should wear a hat to prevent heat loss from the scalp
108
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Symposium 3 - Trauma in Special Population
Seong Hwa Lee (Pusan National Univ. Hospital)
109
Symposium 3 - Trauma in Special Population
Management of Trauma in Pregnant Women
Seong Hwa Lee (Pusan National Univ. Hospital)
Trauma in pregnancy differ in some aspects from trauma of the general public. The first, there
are two patients. The fetus can become a patient depending on the gestational age. Therefore, an
obstetrical evaluation is indispensable even in case of trauma, and emergency delivery may be
necessary in some cases. The second, anatomical change due to pregnancy occur. As the pregnan-
cy week passes, the position of the uterus gradually rises to the upper abdomen, so the position of
the fetus changes, and the position of the abdominal organs also changes. The third, physiologic
changes occur during pregnanacy, too. The amount of fluid is continuously increased until 34
weeks, and the hemoglobin is not increased by the increase of body fluid volume, so there may
be physiological anemia during pregnancy. As a result, cardiac output is increased and heart rate
increases about 10-15 times per minute over the pregnancy period.
The mechanism of trauma in pregnancy is mostly caused by blunt trauma that traffic accidents,
falls, and direct impact of the abdomen, and the penetration is rare. The degree of maternal dam-
age is most important in determining the prognosis of the mother and the fetus. Therefore, The
most important way to treat the fetus is to treat the mother. However, the fetus should be exam-
ined after primary survey of mother because the fetus may be accompanied by severe damage
even if the mother is mildly injured.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
110
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Clinical Assistant Professor, Department of Thoracic and Cardiovascular Surgery
Wonju Severance Christian Hospital, Yonsei University, Wonju College of Medicine
Medical License, Korea - 2005
Korean Board of Thoracic and Cardiovascular Surgery - 2010
Subspecialty Certification for Traumatology - February 2015
Subspecialty Certification for Critical Care Medicine - August 2015
Internship - Gangnam Severance Hospital, Yonsei University, 3. 2005 - 2. 2006
Residency - Severance Hospital, Yonsei University, 3. 2006 - 2. 2010
Fellowship - Severance Hospital, Yonsei University, 3. 2010 - 2. 2012
Assistant Professor - Eulji University , Eulji University Hospital, 3. 2012 - 1. 2013
Clinical Assistant Professor - Yonsei University Wonju College of Medicine, 2. 2013 -
Present
Present title &
Affiliation
Licensure
Specialty Board
Subspecialty
Certification
Professional
Training
Symposium 3 - Trauma in Special Population
Chun Sung Byun (Yonsei Univ. Wonju College of Medicine)
111
Symposium 3 - Trauma in Special Population
Management of Trauma in Geriatric Patients:
Rib Fracture in Octogenerian
Chun Sung Byun (Yonsei Univ. Wonju College of Medicine)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
112
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
2007-2011 College of Medicine, Seuoul National University
2011-2012 Internship, Armed Forces Capital Hospital
2012-2016 Resident, Department of Radiology, Seoul National University Hospital
2016-2017 Director of Healthcare Center, Armed Forces Daejeon Hospital
2017- Clinical fellow of interventional radiology, Department of Radiology,
Seoul National University Hospital
Education
Employment
Symposium 3 - Trauma in Special Population
Taeho Kim (Armed Forces Capital Hospital)
113
Symposium 3 - Trauma in Special Population
Endovascular Treatment of Vascular Injury in
the Military Soldiers
Taeho Kim (Armed Forces Capital Hospital)
Gunshot in the military troop could cause a high energy wound combined with multiple inju-
ries through adjacent bone, soft tissue and vessel. Among these, vascular injury is the most import-
ant factor that determined the survival rate of gunshot patients. Because of these reasons, rapid and
accurate detection and treatment is cruciate to prevent unintended death in the gunshot patient.
Recently, CT angiography has been developed with multiple detectors and it provides prompt
whole-body scan in the patient with severe trauma. Moreover it has a powerful detection ability
using dynamic phase images with contrast administration when the vascular injury is suggested.
Recently, endovascular treatment, such as transcatheter arterial embolization(TAE) is a alternative
treatment option in the patient with vascular injury. Recently TAE for the vascular injury with se-
vere trauma shows high technical successful rate.
In this lecture, we should recognize the characteristics of military casualties and prepare the
alternative treatment of vascular injury such as TAE, because sometimes military trauma is accom-
panied by mass casualties.
Key Words: Gunshot, Embolization, Trauma
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Jun-Dong Moon (Kongju National Univ.)
Moderator
Sun Joo Wang (Hallym Univ. Hospital)
Min Koo Lee (Jeju Halla Hospital)
1F. Seminar 2
Training Course 3 (KR)
Traumatic Cardiopulmonary Arrest (TCPA)
06-23 (Fri.), 2017
115
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Ph.D in Emergency Medicine, College of Medicine, Korea University
Emergency Medicine, Medical Education, Emergency Medical Service
Clinical Professor, Department of Emergency Medicine, Anam Hospital, Korea
University
EMS Physician, Seoul Metropolitan Fire Academy
Education
Area of Expertise
Professional
Experience
Training Course 3 (KR) - Traumatic Cardiopulmonary Arrest (TCPA)
Jun-Dong Moon (Kongju National Univ.)
116
Training Course 3 (KR) - Traumatic Cardiopulmonary Arrest (TCPA)
Traumatic Cardiac Arrest - Similar but
Different
Jun-Dong Moon (Kongju National Univ.)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
117
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1994 - 2000 Korea University College of Medicine Seoul, Republic of Korea
2002 - 2004 Korea University College of Medicine Seoul, Republic of Korea
2005 - 2010 Korea University College of Medicine Seoul, Republic of Korea
2000 - 2001 Korea University College of Medicine
Education
Training
Training Course 3 (KR) - Traumatic Cardiopulmonary Arrest (TCPA)
Young Hoon Yoon (Korea Univ. Hospital)
118
Training Course 3 (KR) - Traumatic Cardiopulmonary Arrest (TCPA)
Airway Matters in Maxillofacial Injury
Young Hoon Yoon (Korea Univ. Hospital)
Airway management outside hospital has been a highly controversial topic. Cancellation of air-
way management in a difficulty situation may not be an option in the acute trauma setting as well
as pre-hospital setting.
Development of the ‘airway-breathing-circulation’ approach for the management of severely
ill and injured patients, initiated by Advanced Life Support and Advanced Trauma Life Support
courses remains worldwide clinical practice. While airway management in pre-hospital setting con-
tributes to patient’s good outcome, available evidence for pre-hospital airway management is still
controversy.
However, there are small but significant proportion of pre-hospital trauma patients require early
advanced airway intervention. This intervention should be done delaying time to arrival at hos-
pital. The procedure is performed whenever patient need it even if the system cannot provide it
comfortably or safely.
When you start to manage the airway of trauma patient, you should always consider patient
evaluation, intervention using various techniques and devices, recognition of any trauma to the
airway or surrounding tissues, anticipation of their respiratory consequences, and planning and ap-
plication of management, the potential for exacerbation of existing airway or other injuries by the
contemplated strategies.
In this session, the evidence surrounding early emergency airway management after injury is ex-
amined, and the use of various airway device in many different situation is introduced.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
119
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Graduated from Chonnam National University of Medicine
Internship at Chonnam National University Hospital
Complete a Course of Resident in Thoracic surgery
ESPIT Instructor
Member of KARPET (Korean Association for Research, Procedures and Education on
Trauma)
(Present) Team of Trauma Center in Mokpo Hankook Hospital
Experience
Training Course 3 (KR) - Traumatic Cardiopulmonary Arrest (TCPA)
Jaykey Chekar (Mokpo Hankook Hospital)
120
Training Course 3 (KR) - Traumatic Cardiopulmonary Arrest (TCPA)
Cardiac Arrest Associated with Chest Injury
Jaykey Chekar (Mokpo Hankook Hospital)
The cardiac arrest following chest injury involves a high mortality rate. In most cases, it reflects a
cardiac tamponade, tension pneumothorax, or hemorrhagic shock resulting from injury to the heart
or large vessels nearly. Therefore, immediate decompression of tension pneumothorax, tamponade
and adequate volume restoration are important in resuscitation of cardiac arrest following chest in-
jury. Rapid resuscitative thoracotomy to allow direct cardiac massage, decompression of hemoperi-
cardium, and bleeding control is important as well. However the probability of survival described
in the literature is very low for severe chest trauma with cardiac arrest. But some guidelines recom-
mend that all patient in cardiac arrest with suspected chest trauma who are not responding to air
way opening and restoration of circulating blood volume should have their chest decompressed.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1998-2004 Yonsei University Wonju College of Medicine - Medicine
2007-2015 Yonsei University of Graduate School - Emergency Medicine
2014- Present Wonju Severance Chrstian Hospital Emergency Medicine,
Trauma Surgery
2009- Present Korean Society of Echocardiogaraphy
2007- Present The Korean Society Tramatology
2009-2015, Present The Korean Society of Emergency Medicine Emergency Medicine
2009- Present
2015 National Education of Rescue Training Institute
2015 The Korean Society of Emergency Medicine (Triage)
2016 - Korean Association of Aero Emergency Medical Service
Education
Experience
Society
Training Course 3 (KR) - Traumatic Cardiopulmonary Arrest (TCPA)
Oh Hyun Kim (Yonsei Univ. Wonju College of Medicine)
122
Training Course 3 (KR) - Traumatic Cardiopulmonary Arrest (TCPA)
Prehospital eFAST : Evidence-Based
Recommendations
Oh Hyun Kim (Yonsei Univ. Wonju College of Medicine)
Ultrasonography examination of trauma patients is increasingly performed in prehospital era in
developed countries. But it is obscure that if prehospital sonography have a postivie effect in trau-
ma patients. While there is moderate evidence to support the use of prehostpial ultrasonography
in physician-staffed emergency medical services, the evidence is lacking of the utility of ultrasonog-
raphy with a non-physician-saffed EMS.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Chan Yong Park (Pusan National Univ. Hospital)
Moderator
Chan Yong Park (Pusan National Univ. Hospital)
1F. Seminar 2
Special Lecture
REBOA
06-23 (Fri.), 2017
124
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1989-1995 Medical School, St. Marianna University School of Medicine
Assistant Professor, Department of Emergency and Critical Care Medicine, St Marianna
University School of Medicine, Kawasaki, Kanagawa, Japan: 2007-Present
Chief, Division of Emergency and Trauma Radiology, Department of Emergency
and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki,
Kanagawa, Japan: 2006-Present
Director, Department of Radiology, National Disaster Medical Center: 2007-Present
Secretary General, Japanese Society of Emergency Radiology: 2005-2016
President, International Society for Diagnostic and Interventional Radiology in
Emergency, Critical Care and Trauma (DIRECT): 2016-Present
Attending Staff Radiologist: Division of Emergency and Trauma Radiology, Department
of Emergency and Critical Care Medicine, St Marianna University School of Medicine,
Kawasaki, Kanagawa, Japan: 2005-2007
Research Fellow, Division of Emergency and Trauma Radiology, Shock Trauma Center,
University of Maryland, Baltimore, Maryland, US: 2004-2005
Attending Staff Radiologist: Department of Radiology, St Marianna University School
of Medicine, Kawasaki, Kanagawa, Japan: 2001-2004
2013-Present General Member, Radiological society of North America
Education
Current Affiliation
Past Affiliation
Society
Memberships
Special Lecture - REBOA
Junichi Matsumoto (St. Marianna Univ. JAPAN)
125
Special Lecture - REBOA
REBOA; Resuscitative Endovascular Balloon
Occlusion of the Aorta
Junichi Matsumoto (St. Marianna Univ. JAPAN)
REBOA; Resuscitative Endovascular Balloon Occlusion of the Aorta has been getting its position
in trauma care. Although the concept of this procedure looks very simple, you have to learn a lot
before you do it. The goal of this lecture is to learn; 1) the concept, 2) indication, 3) the technique,
4) the complications, and 5) further application of REBOA.
Strong evidences for this technique has not come up and its usefulness, effectiveness and harm-
fulness has been under discussion. It is essential to master basic skills of this procedure to apply it
safely and properly in critically injured patients. It is also very important to understand this proce-
dure is not the definitive solution but just a bridging technique for definitive hemostatic therapy by
surgical or radiological intervention with adequate transfusion. You have to have the right team to
work under the right concept, otherwise you cannot save your patients with REBOA.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Chan Yong Park (Pusan National Univ. Hospital)
Moderator
Jeong Ho Kim (Gachon Univ. Gil Hospital)
Hang Joo Cho (The Catholic Univ. Hospital)
1F. Seminar 2
Symposium 2
Bleeding Control in Pelvic Fracture
06-23 (Fri.), 2017
127
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1999-2005: Bachelor’s Degree, Kosin University College of Medicine
2009-2015: Master’s Degree, Graduate School, Yonsei University College of Science
(Graduate Program of Nano Science and Technology)
2012.03-2014.02
Clinical and Research Fellow in Division of Surgical Critical Care and Trauma,
Department of Surgery, Severance Hospital, Yonsei University Health System, Seoul,
Korea
2014.03-
Clinical Assistant Professor in Department of Surgery, Wonju Severance Christian
Hospital, Yonsei University Wonju College of Medicine
2013 Board of Critical Care Medicine (The Korean Society of Critical Care Medicine)
2014 Board of Traumatology (The Korean Society of Traumatology)
Education
Training and
Fellowship Course
Professional
Experiences
Qualification
Symposium 2 - Bleeding Control in Pelvic Fracture
Ji Young Jang (Yonsei Univ. Wonju College of Medicine)
128
Symposium 2 - Bleeding Control in Pelvic Fracture
Preperitoneal Pelvic Packing in Patients with
Hemodynamic Instability Due to
Pelvic Fracture
Ji Young Jang (Yonsei Univ. Wonju College of Medicine)
The mortality rate of patients with hemodynamic instability due to severe pelvic fracture is re-
ported to be 40-60% despite a multi-disciplinary treatment approach. Angioembolization and exter-
nal fixation of the pelvis are the main procedures used to control bleeding in these patients. Sever-
al studies have shown that preperitoneal pelvic packing (PPP) is effective for hemorrhage control,
despite being small and observational in nature. In this lecture, author will explain physiologic and
anatomic concepts of PPP application in patients with pelvic fracture and shock, and will present a
regional trauma center’s early experience about this topic.
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
2011: Master. Ulsan University of Graduate School (Medicine)
2014: Doctor. Catholic Kwandong University of Graduate School (Medicine)
2011~ 2012: Clinic Assistant Professor at Gangneng Asan Medical Center
2013 ~ 2016: Clinic Assistant Professor of Trauma Surgery at The Catholic University
of Korea, Yeouido St. Mary’s Hospital
2017 ~ Present: Assistant Professor at Ulsan University Hospital
Member of The Korean Society for Vascular Surgery
Member of Korean Surgical Society
Education
Experiences
Society
Symposium 2 - Bleeding Control in Pelvic Fracture
Ji Hoon Kim (Ulsan Univ. Hospital)
130
Symposium 2 - Bleeding Control in Pelvic Fracture
Internal Iliac Artery Ligation
Ji Hoon Kim (Ulsan Univ. Hospital)
General Considerations
Either a midline or a transverse abdominal incision may be used. In most situations, bilateral
ligation is preferable to unilateral ligation. Not only is hemostasis more secure, but also any doubt
about a possible return to the operating room is removed. Although it is possible to perform the
operation by the extraperitoneal approach, the intra-abdominal approach is preferable except in
cases of extreme obesity. Some surgeons advocate complete transection of the hypogastric vessel
between two ligatures. This has no practical or physiologic advantage. On the contrary, its prac-
tice may lead to injury of the underlying veins. If such an injury should occur in the course of the
operation, applying pressure with a gauze sponge or suturing with an atraumatic needle and fine
suture material usually suffices to repair the defect. If this should fail, however, the vein itself can
be ligated above and below the defect. Incorporation of the previously tied artery into the suture
in the vein adds strength and security as well as a splinting effect. Two ties should be placed firmly
but gently in continuity approximately 0.5 cm apart and 0.5-1 cm below the bifurcation.
Transabdominal Approach
The abdomen is opened and the viscera packed away in the usual manner. Identification of the
bifurcation of the common iliac artery is made by the two bony landmarks: the sacral promontory
and an imaginary line drawn through both anterosuperior iliac spines. A longitudinal incision into
the posterior parietal peritoneum is made. Another method is to incise into the peritoneum directly
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The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
over the bifurcation. The incision then is carried distally a few inches. All these incisions have one
feature in common: They result in the formation of a medial and lateral peritoneal flap. The ureter
is always on the medial flap and may be visualized, reflected, and protected with ease. The ureter
normally crosses the common iliac artery from lateral to medial at a point just proximal to the bifur-
cation.
Extraperitoneal Approach
The skin incision in the inguinal area parallels the course of the external oblique muscle. It runs
6-8 cm in length in a line 3-5 cm medial to the anterosuperior iliac spine. After the fat and subcu-
taneous tissues are dissected away, a muscle-splitting incision bares the peritoneum. This is gently
reflected medially, exposing the posterior surface; the ureter is reflected medially and the vessels
laterally. Ligation is performed as previously described. Closure is the same as for a herniorrhaphy
Midline Extraperitoneal Approach
A midline extraperitoneal approach to the aorta is advocated by some. One authority extended
its use to bilateral ligation of the hypogastric arteries. A midline abdominal incision is made. After
the anterior sheath of the rectus muscle is exposed and opened below the level of the umbilicus,
dissection caudal to the semilunar line of Douglas is performed, and the peritoneal and preperito-
neal fat are separated. The peritoneum and its contents are reflected to the right (or left), thus ex-
posing the retroperitoneal structures
Summarized of Surgical Management of intractable pelvic hemorrhage Keith, L, Lynch, C, Glob. libr. women’s
med. 2008
132
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Ulsan University, Seoul, Korea / Master of Medicine
Orthopedic Surgery, Medicine , February 2009
Orthopedic Surgery, Medicine , February 2005
Ulsan University, Seoul, Korea / Doctor of Medicine
Medicine, February 2000
3/2000 - 2/2001 Asan Medical center, Internship
3/2001 - 2/2005 Asan Medical center, Residency
3/2005 - 4/2008 Army Hospital, Army Surgeon
5/2008 - 2/2009 Asan Medical center, Fellowship
3/2009 - 2/2010 Asan Medical center, Fellowship
10/2013 - 12/2014 Denver Health Medical Center / Visiting Scholar & Research Fellow
3/2010 - 10/2016 Inje University, Haeundae Paik Hospital / Assistant Professor,
Associate Professor
Education
Experiences
Symposium 2 - Bleeding Control in Pelvic Fracture
Ji Wan Kim (Inje Univ. Hospital)
133
Symposium 2 - Bleeding Control in Pelvic Fracture
Bleeding Control in Pelvic Fracture;
Bony Stabilization
Ji Wan Kim (Inje Univ. Hospital)
1. Classification of pelvic fractures
Among the various categories of pelvic fractures, the tile classification and is widely used be-
cause the stability of the pelvis can be determined. Type A is a stable type fracture that does not
involve the posterior ring of the pelvis, Type B is a type of fracture involving rotational unstable
fracture, and type C is complete disruption of the posterior ring resulting vertical instability.
In open book type, type B1 fracture and type C fracture are accompanied by massive bleeding
and immediate treatment is needed. According to Cryer et al., Open book type showed 56% to 10
pint Transfusion of more than 10 pints was required in 33.3% of B2,3 type transitional cases with
a transposition of 0.5 cm or more and 47% of C type with transposition of 0.5 cm or more. The
anterior and posterior radiographs should be taken and the injury of the anterior ring, including the
symphysis pubis, may be more easily detected than the injury of the posterior ring. According to
Mears and Rubash, diastasis of 3 cm of symphysis pubis increases the pelvic volume by 1.5 L.
2. Hemodynamic instability and bony fixation
Hemorrhage in pelvis fracture is caused by pelvic artery injury, fracture site hemorrhage, and
pelvic venous plexus injury. Hewtenen and Slatis reported that 85% of hemorrhages were due to
venous injury and fracture sites. There are various methods for hemostasis, which are performed
according to the patient’s condition, availability of medical resources, and manpower. In general,
methods such as pelvic binder (sling), external fixation, internal fixation, direct surgical vascular
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
ligation, pelvic packing.
Although pelvic sheets or pelvic binders can be easily performed in emergency or emergency
rooms, caution is advised because lateral compression of the pelvic fracture can make the fracture
worse. Pelvic binder may be helpful in reducing the enlarged pelvic volume in the open book
type, but there is controversy over whether the tamponade effect is effective due to the damage of
the posterior ring.
External fixations are effective methods of hemostasis through the reduction and stabilization of
fracture, tamponade effect that reduces the volume of the retroperitoneal space, and the hemosta-
sis of the venous plexus due to the formation of retroperitoneal hematoma.
Anterior ring fixation can be accomplished with external fixation, but posterior ring fixation can
be achieved by C-clamp. In hemodynamically unstable patients, it is preferable to reduce the oper-
ation time as much as possible using an external bone fixation device. However, iliosacral screw or
internal fixation with plate are sometimes useful to manage bleeding.
135
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1985-1991, Pusan National University College of Medicine, M.D.
1992-1997, Pusan National University Postgraduate School, Master Degree of
Medicine
2000-2005, Pusan National University Postgraduate School, Doctor Degree of
Medicine
March 2001- Feb. 2008, Professor by fund, Department of Radiology, Pusan National
University
March 2005 - May 2005, Visiting Professor in Kurume University Hospital, Fukuoka,
Japan
March 2008 - Feb. 2009, Assistant Professor, Department of Radiology, Pusan
National University
March 2009 - Feb. 2014, Associate Professor, Department of Radiology, Pusan
National University
Feb. 2010 - Feb. 2011, Visiting Professor in Auckland City Hospital, Auckland, New
Zealand
March 2014 - Professor, Department of Radiology, Pusan National University
March 2016 - Director of Department of Radiology, Pusan National University Hospital
Interventional Radiology
Cardiovascular Imaging
Education
Professional
Training and
Employment
Specialty
Symposium 2 - Bleeding Control in Pelvic Fracture
Chang Won Kim (Pusan National Univ. Hospital)
136
Symposium 2 - Bleeding Control in Pelvic Fracture
Interventional Radiology for Pelvic Trauma
Chang Won Kim (Pusan National Univ. Hospital)
Hemorrhage from pelvic trauma is a significant source of mortality and necessitates a multidisci-
plinary, algorithm-directed protocol. Embolization is an established endovascular technique useful
in the emergency treatment of many traumatic injuries. Embolization is a lifesaving procedure that
can control bleeding in an expeditious and minimally invasive manner by the intentional and con-
trolled occlusion of vessels to stop hemorrhage. MDCT images are invaluable to guide the angiog-
raphy when searching for areas of suspected injuries with selective angiograms. In the majority of
cases, selective or superselective angiograms are always required to rule out any injuries and active
contrast extravasation.
Multidisciplinary trauma teams with established protocols that help to decide when emboliza-
tion and/or surgery are required are a critical part of the modern management of arterial injuries.
Embolization should be performed early in the control of arterial bleeding before severe coagulop-
athy develops. For these reasons, interventional radiologist should be an active member of trauma
team. Familiarity with clinical presentation, pretreatment imaging, angiographic findings, and en-
dovascular techniques are all essential components to effective diagnosis and treatment of trauma
patients with embolotherapy.
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1995.2: Graduate Seoul National University College of Medicine
1995.2: M.D. Certified, Seoul, Korea
2000.2: Radiology Board Certified by Korean Radiological Society, Seoul, Korea
2007.2: Seoul National University, Ph.D., Seoul, Korea
2012.4-2017.2: Associate Professor in Radiology & Emergency Medicine, Seoul
National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
2017.3-Present: Professor in Radiology & Emergency Medicine, Seoul National
University Hospital, Seoul National University College of Medicine, Seoul, Korea
Since 2000: Member, Korean Radiological Society
Since 2003: Member, Koran Society of Interventional Radiology
Since 2005: Member, ASER (American Society of Emergency Radiology)
Since 2006: Member, SIR (Society of Interventional Radiology)
Since 2010: Member, CIRSE (Cardiovascular and Interventional Radiological Society of
Europe)
Since 2012: President, KSER (Korean Society of Emergency Radiology)
Education
Professional
Appointments
Other Professional
Positions
Symposium 2 - Bleeding Control in Pelvic Fracture
Hwan Jun Jae (Seoul National Univ. Hospital)
138
Symposium 2 - Bleeding Control in Pelvic Fracture
Panel Discussion
Hwan Jun Jae (Seoul National Univ. Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Bo-Ra Seo (Mokpo Hankook Hospital)
Moderator
In Ho Park (Mokpo Hankook Hospital)
Seong-Keun Moon (Wonkwang Univ. Hospital)
1F. Seminar 2
Symposium 4
Common Questions about Neurotrauma : Non-Neurosurgeon's View
06-23 (Fri.), 2017
140
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Graduated from Pusan University of Medicine
Manager at Changwon Hospital
Neurosurgeon at Pusan National University Hospital
Trained at Osaka Prefectural Acute and General Medical Center
(Present) Clinic Assistant Professor of Neurosurgery at Pusan National University
Hospital (in Full Charge of Trauma Center)
Member of Korean Board of Neurosurgery
Life-Member of Korean Spinal of Neurosurgery Society
Life-Member of Korean Neurotraumatology Society
Education
Experience
Society
Symposium 4 - Common Questions about Neurotrauma : Non-Neurosurgeon's View
Hyuck Jin Choi (Pusan National Univ. Hospital)
141
Symposium 4 - Common Questions about Neurotrauma : Non-Neurosurgeon's View
Optimal BP & ICP & CPP in TBI Patients
Hyuck Jin Choi (Pusan National Univ. Hospital)
Intracranial pressure (ICP) is the pressure inside the cranial vault and is affected by intracranial
contents, primarily brain, blood, and cerebrospinal fluid. The intracranial volume is constant. Since
the intracranial vault is a fixed space, ICP increases with an increase in brain volume and cerebral
blood volume, increased cerebrospinal fluid production, and or decreased cerebrospinal fluid
clearance. Mass lesions such as tumors, hemorrhagic lesions, cerebral edema, or obstruction of ve-
nous and or CSF return can increase ICP. As mass lesions (such as traumatic brain swelling) occu-
py more volume, intracranial compliance decreases, and elasticity increases. A critical threshold is
reached when space-occupying lesions can no longer expand without neuronal injury, herniation,
and brain death. It is important to remember that the idea of ICP, while important in itself, must
also be considered in the context of its inverse relationship with cerebral perfusion pressure, which
is discussed elsewhere.
The level of systolic blood pressure (SBP) has long been felt to play a critical role in the second-
ary injury cascade after severe traumatic brain injury (TBI). In 1989, Klauber reported a mortality of
35% in patients admitted with a SBP <85 mm Hg, compared with only 6% in patients with a higher
SBP. The traditional definition of hypotension has been a SBP <90 mm Hg, and this was the target
recommended. As will be noted, the literature now supports a higher level that may vary by age.
The 5th Pan Pacific Trauma Congress
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1997.3.~2003.2. Dankook University College of Medicine B.S. (Medicine)
2009.3.~2011.2. Dankook University Graduate School of Medicine M.S. (Medicine)
2003.3.~2004.2. Intern in Dankook University Hospital
2007.5.~2011.2 Resident in the Department of Neurosurgery, Dankook University
Hospital
2010.8.~2010.9. Visiting Scholar, Nagoya University Hospital (Cerebrovascular
Surgery-SUGITA scholarship)
2011.3.~2013.2. Clinical Instructor (fellowship), Asan Medical Center, Department of
Neurosurgery (Vascular and Brain Tumor Section)
2013.3.~2016.2. Clinical Assistant Professor (Neurotrauma and Neurovascular
Surgery), Dankook University Hospital, Trauma Center and Department of Neurosurgery
2016.3~Present. Assistant Professor (Neurotrauma and Neurovascular Surgery),
Dankook University, College of Medicine, Trauma Center and Department of
Neurosurgery
Education
Postgraduate
Training
Hospital
Appointment
Symposium 4 - Common Questions about Neurotrauma : Non-Neurosurgeon's View
Jung-Ho Yun (Dankook Univ. Hospital)
143
Symposium 4 - Common Questions about Neurotrauma : Non-Neurosurgeon's View
Multimodality Monitoring in TBI Patients
Jung-Ho Yun (Dankook Univ. Hospital)
One of the most important goals of neurologic critical care is to detect secondary brain injury
at a time when permanent damage can still be prevented. The clinical examination remains the
gold standard for the assessment of patients with neurologic disease despite great advances in
neuroimaging and other diagnostic tools. The main purpose of invasive neuromonitoring is to
create this window of opportunity between the onset of functional disarray and neuronal injury.
It is therefore, of fundamental importance for any unit that engages in invasive brain monitoring
to have the infrastructure in place to react to detected changes in a timely fashion. Partial pressure
of brain tissue oxygen (Pbto2) is a measure of cerebral oxygen tension reflecting oxygen delivery,
diffusion, and consumption in the brain tissue. Optimizing Pbto2 may potentially improve aerobic
metabolism. Cerebral microdialysis is a technique through which the concentrations of lactate, glu-
cose, pyruvate, glycerol, and glutamate can be monitored in the brain tissue. Alternations in these
metabolites may be early indications of metabolic disarray, such as anaerobic metabolism. Jugular
venous oxygen saturation (Svjo2) and the arterial-jugular difference of oxygen content (AJDo2)
are measures of global oxygen extraction by the brain. High Svjo2 may reflect hyperemia and low
Svjo2 may reflect inadequate cerebral perfusion and possibly ischemia. Reginal cerebral blood flow
(rCBF) is a direct assessment of local brain tissue perfusion, and a surrogate of this can be obtained
with a thermal diffusion probe inserted into the brain parenchyma.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1992-1994 Yonsei University Graduate School, M.M.Sc.
1997-1999 Korea University Graduate School, D.M.Sc.
2003-2005 Department of Neurosurgery, Research professor, University of Utah
2008-Present Professor , Neurosurgery, Wonju college of Medicine, Yonsei University,
Wonju, Korea
2013-2017 Director, Office of Planning and Coordination, Yonsei University, Wonju
Health System, Wonju, Korea
The Korean Neurosurgery Society (1994- Present)
The Korean Neurotrauma Society, Chairman (2012-2013)
The Korean Cerebrovascular Society(1997- Present)
The Korean Brain Tumor Society (1997- Present)
Asian Congress of Neurological Surgery (1998- Present)
Korean Society of Critical Care Medicine (2009- Present)
Education &
Training
Experience
Society
Symposium 4 - Common Questions about Neurotrauma : Non-Neurosurgeon's View
Kum Whang (Yonsei Univ. Wonju College of Medicine)
145
Symposium 4 - Common Questions about Neurotrauma : Non-Neurosurgeon's View
Indications & Timing of Decompressive
Craniectomy
Kum Whang (Yonsei Univ. Wonju College of Medicine)
After traumatic brain injury (TBI), intracranial pressure can be elevated owing to a mass effect
from intracranial hematomas, contusions, diffuse brain swelling. Intracranial hypertension can lead
to brain ischemia by reducing the cerebral perfusion pressure and is associated with an increased
risk of death.
Decompressive craniectomy (DC) is a surgical method for immediate reduction of intracranial
pressure (ICP).
The rationale of DC is based in the Monro-Kellie Doctrine. If pathologic conditions that increase
ICP is happened, compensatory mechanisms operate to keep ICP constantly. There is exponential
relationship between intracranial volume and ICP. A CPP less than 60 to 70 mmHg is associated
with diminished oxygenation and altered metabolism in brain parenchyme. It is clear that patients
with untreated ICP (ICP ≥20 mmHg) after TBI will result poor outcomes, and improved ICP cor-
relates with functional outcome. Current Brain Trauma Foundation guidelines suggested the ICP
lower than 20 to 25 mmHg after TBI. Patients with well-controlled ICP under the threshold appear
to have improved outcomes. The treatment of increased ICP is very important for the prognosis of
patients. Initial managements used such as analgesia, sedation, elevation of the head, CSF drainage
through a ventricular cathe ter (if present), and optimization of ventilation to maintain normal arte-
rial partial pressure of carbon dioxide. Tier therapies are followed as intravenous administration of
hyperosmolar solutions, neuromuscular blocking agents, hypothermia, and barbiturate coma thera-
py.
At recent RESCUEicp study, this is secondary DC. At 6 months, DC in patients with TBI and
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
refractory intracranial hypertension resulted in lower mortality and higher rates of vegetative state,
lower severe disability, and upper severe disability than medical care. The rates of moderate dis-
ability and good recovery were similar in the two groups.
147
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
2011-2012 Severance Hospital Clinical Spine Surgery Seoul, South Korea Fellow
2009-2011 Yonsei University M.S. Neurosurgery Seoul, South Korea
2003 Korean National Board of Medical Examiners
2008 Korean Board of Neurosurgery
7/1/2012 - Present Ajou University Hospital, School of Medicine
Department of Neurosurgery Neurotrauma and Spinal
Neurosurgery Division Clinical Assistant Professor
3/1/2014 - Present Ajou University Hospital, School of Medicine
Regional Trauma Center Neurotrauma Division
Education
License,
Certification
Principal
Position Held
Symposium 4 - Common Questions about Neurotrauma : Non-Neurosurgeon's View
Nam Kyu Yu (Ajou Univ. Hospital)
148
Symposium 4 - Common Questions about Neurotrauma : Non-Neurosurgeon's View
Neurologic Sign and Neuroimaging
Suggesting Poor Prognosis
Nam Kyu Yu (Ajou Univ. Hospital)
The prognosis of Traumatic Brain Injury (TBI) has been improved with establishment of several
treatment strategies. The basis is consisted with development of imaging modalities, neurointensive
care, invasive intracranial monitoring and aggressive control of intracranial pressure. However, the
prognosis of severe traumatic brain injury remains still poor.
Initial neurologic assessment should be taken after airway maintenance, breathing and circula-
tion. Glasgow coma scale is widely used neurologic assessment examination. It is consisted with
Eye opening, Verbal response and Motor response. Motor response was more predictable compo-
nent than others. In intubated patients, Verbal response may be calculated using equation.
Pupil Light Reflex (PLR) is simple and important in TBI patient. An abnormal finding in PLR
represents brain stem dysfunction. Optic nerve and third cranial nerve injury should be ruled out.
Anisocoria means herniation and compression of brain stem and it usually means immediate surgi-
cal decompression is required.
Other detectable reflexes are coughing reflex, corneal reflex and gag reflex. The absence of
these reflexes means severe brain stem dysfunctions which may progress to brain death. Drug in-
toxication and alcohol ingestion may cause underestimation of neurologic status.
Computed tomography is most rapid and valuable imaging protocol in acute trauma patient.
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The 32nd Annual Meeting of the Korean Society of Traumatology
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Plain radiography is very inadequate. Contrast enhancement is useful in neurologically deteriora-
tion but trauma history is uncertain. Ultra-early examination is not a guarantee for better outcome.
TBI patient may deteriorate rapidly in several hours. Short term follow up is recommended in risky
patient. Dangerous traumatic mechanism or patients on anticoagulation should be considered for
short term imaging follow up.
Swirl sign in hematoma on CT means that there is active bleeding. It usually predicts rapid de-
terioration requiring surgical treatment.
Diffuse injury may not be detected on CT scan. Diffuse axonal injury defines persistent coma-
tose mentality with no causable intracranial lesion on CT scan. In this situation, MRI scan will help
to find out the cause. Multiple microbleedings, injury of axial structures - corpus callosum, mid-
brain and brain stem - may be seen in MRI scan. Without stem injury, patients with diffuse axonal
injury will recover their mentality but may be with cognitive dysfunction. Brain stem injury causes
delayed mental recovery and severe autonomic dysfunction.
Signs and findings predicting poor outcome is important to decide management modality and
give consent to patients and their family. And appropriate work up and treatment to these signs
and findings will reduce mortality and morbidity of TBI patients.
150
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
2004.09-2006.08: Postgraduate Master Course, Graduate School of SNU (Degree of M.S.)
2007.03-2009.02: Postgraduate Doctoral Course, Graduate School of SNU (Completed)
2011.12- Present: Public Servant, Department of Neurosurgery, The Armed Forces
Capital Hospital, South Korea
2012.08-Present: Chief of Spine center, The Armed Forces Capital Hospital, South
Korea
2014.02-2016.01: Chief of Planning and Coordination Bureau, The Armed Forces
Capital Hospital, South Korea
2014.02-Present: President, Korean Military Society for Quality in Health Care,
South Korea
2016.02-Present: President of Department of Neurosurgery, The Armed Forces
Capital Hospital, South Korea
2016.06-Present: Director of Military Neurotraumatology, The Korean
Neurotraumatology Society, South Korea
2016.12-Present: Chief of Task Force Team of Construction and Establishment of
Korean Armed Forces Trauma Center
The Koran Medical Association
The Korean Neurosurgical Society
The Korean Neurotraumatology Society
Education
Professional
Career
Membership in
Societies
Symposium 4 - Common Questions about Neurotrauma : Non-Neurosurgeon's View
Sang Hoon Yoon (Armed Forces Capital Hospital)
151
Symposium 4 - Common Questions about Neurotrauma : Non-Neurosurgeon's View
Experiences of Spinal Trauma in Military
Hospital
Sang Hoon Yoon (Armed Forces Capital Hospital)
Objectives: This study analyzed and reviewed to know the clinical result and characteristics of
spinal cord injury (below ASIA grade D) and vertebral fractures managed with surgical treatment in
the Armed Forces Capital Hospital for 6 years experiences.
Materials and Methods: Korean military personnel who sustained a spine injury that result-
ed in neurological deterioration (below ASIA grade D) and vertebral fractures which should be
managed with surgery from November 2011 to June 2017. Demographic and injury-specific char-
acteristics were abstracted for each individual identified. The raw incidence of spinal injuries was
calculated and correlations were drawn between the presence of spinal trauma and military spe-
cialty, mechanism and manner of injury. Significant associations were also sought for specific injury
patterns, including low thoracic and upper lumbar vertebral fractures. Clinical result was checked
by ASIA scaling and radiological data.
Results: Among 155,220 patients who visited Neurosurgical department in the Armed Forces
Capital Hospital for 6 years, total 60 patients who suffered from traumatic spinal injury and ver-
tebral fractures with or without neurological deterioration underwent surgery. 33.3 percent of all
casualties under the surgical management with spinal injury were suffered from neurological de-
terioration and 10 caused by suicide attempt, 5 by fall down during military training, 5 caused by
parachute descents. Spinal burst fracture was the most common type of injury (n = 31), while spi-
nal dislocations occurred in 2. Two sustained cervical spine injury. Spinal cord injuries(N=13) were
more likely to occur as ASIA grade A in 1, B in 3, C in 6, and D in 10. Significant improvement
after operation was shown in 13 by ASIA scale. Most common remnant neurological deterioration
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was lower extremity weakness with or without paraparesis and bladder bowel symptoms. Most
common involved levels of vertebral fractures was the thoracolumbar junction (n=25). About Half
of thoracolumbar injury cases (n=13) were performed by anterior reconstruction of vertebral body
and fixation only and all of them achieved good clinical outcomes about restroration of kyphotic
deformity and neurological improvement.
Conclusion: Most of spinal cord injury achieved good improvement after early surgical inter-
vention. Thoracolumbar fracture were restored to good neurological status and stability only by
anterior corpectomy and fusion. But ASIA A was poor prognostic factor after surgery. Early decom-
pression will promise clinical better outcome and improvement.
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Jongbouk Lee (National Medical Center)
Moderator
Jongbouk Lee (National Medical Center)
Kang-Hyun Lee (Vice-President, The Korean Society of Traumatology)
1F. Main Auditorium
Plenary Session 3
Step by Step 2017
06-24 (Sat.), 2017
154
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Plenary Session 3 - Step by Step 2017
Takashi Fujita (Chairman, Committee on International Liaison, JAST Associate Professor, Trauma and Resuscitation Center, Teikyo Univ.)
1999-2008 Research Fellow in Nagoya University Graduate School of Medicine
2010 The Degree of “Doctor of Medical Science (PhD)” was Awarded
from Teikyo University
2011-Present Associate Professor in Trauma and Resuscitation Center
Department of Emergency Medicine, Teikyo University
2009-2011 Assistant Professor in Trauma and Resuscitation Center
Department of Emergency Medicine, Teikyo University
2000 Board Certificate Member of the Japanese Association of Acute
Medicine (Present; Senior Fellow of he Japanese Association of
Acute Medicine)
2008 Board Certification Member in the Japanese Organization of Cancer
Therapy
2013-Present Active Member - International Surgical Society ( ISS/SIC)
2013-Present General Secretariat of in International Association of Trauma and
Intensive Care(IATSIC) - Japan chapter in International Surgical
Society ( ISS/SIC)
Course Coordinator International Association of Trauma and
Intensive Care(IATSIC)
Education
Professional
Training and
Employment
Licensure and
Certification
Profesessional
Activity
155
Plenary Session 3 - Step by Step 2017
Management of Traumatic Patients in Japan
Takashi Fujita (Chairman, Committee on International Liaison, JAST Associate Professor, Trauma and Resuscitation Center, Teikyo Univ.)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Dr Kenneth Mak is a general surgeon with subspecialty clinical interests in hepatobiliary and pancreatic
surgery, surgical critical care as well as in trauma surgery. He maintains his clinical practice as a Senior
Consultant in the Department of Surgery, at Khoo Teck Puat Hospital, Singapore.
Dr Mak co-chairs the National Trauma Committee in Singapore and is a member of the National Pre-Hospital
Emergency Care Steering Committee. He is also member of the IATSIC International Training Faculty for the
Definitive Surgical Trauma Course (DSTC) and a Course Director for the National Advanced Trauma Life Support
Course in Singapore.
Dr Mak is a Clinical Associate Professor with the Yong Loo Lin School of Medicine, National University of
Singapore. He is a member of the Specialist Accreditation Board and an Executive Council member of the Joint
Committee for Specialist Training. He further heads the General Surgery Residency Advisory Committee, which
oversees General Surgery specialty training in Singapore.
Dr Mak is also the Deputy Director of Medical Services, Health Services Group in the Ministry of Health,
Singapore. He is responsible for the provision of health services by all public acute and community hospitals,
as well as primary care clinics in Singapore.
Dr Mak serves in the Singapore Armed Forces and holds the rank of Colonel. He has held command and staff
appointments at Battalion, Brigade and Divisional levels.
Plenary Session 3 - Step by Step 2017
Kenneth Mak (Khoo Teck Paut Hospital)
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Plenary Session 3 - Step by Step 2017
Management of Pancreatoduodenal Injuries
Kenneth Mak (Khoo Teck Paut Hospital)
Injuries to the pancreas and duodenum pose diagnostic and therapeutic challenges to the sur-
geon. A high index of suspicion, sound clinical judgement and adherence of damage control prin-
ciples can allow for good clinical outcomes in the treatment of such injuries. Complex pancreato-
duodenal injuries, with associated vascular injuries, may require more challenging surgical repair.
This presentation outlines the main principles that guide resuscitation and treatment of patients
with pancreatoduodenal trauma. The evolving role of surgery is discussed, both in the treatment of
pancreatoduodenal injury, but also in the management of complications.
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Chief of Trauma and Surgical Critical Care-San Antonio Military Medical Center
2015 to Present
Chief of General Surgery-San Antonio Military Medical Center 2015
Co-Director Surgical and Trauma ICU - San Antonio Military Medical Center
2014-2015
Trauma Fellowship, University of Hawaii, Honolulu, HI / 2007-2008
Program Director: Dr. Hao Chih Ho
Surgical Critical Care Fellowship, University of Hawaii, Honolulu, HI / 2006-2007
Program Director: Dr. Mihae Yu
General Surgery Residency, Eisenhower Army Medical Center, Fort Gordon, GA
2001-2005
1983-1988
Examiner-2012, 2011, 2009
Postoperative Fluid and Electrolytes- Tripler Army Medical Center Cardiac
Nurse Course Dec 2009, Jul 2012
Member American Association of Trauma Since 2013
Fellow American Board of Surgeons Since 2010
Member Society of Critical Care Medicine 2007
Board Certified Surgical Critical Care October 1, 2007 Expires July 2018
Board Certified General Surgery March 21, 2006 Expires 2028
Positions
Academic
Education
Licensure/
Certification
Plenary Session 3 - Step by Step 2017
Kurt Edwards (COL, San Antonio Military Medical Center)
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Plenary Session 3 - Step by Step 2017
The Trauma System as San Antonio Military
Medical Center: A Paradigm for a
National Trauma System
Kurt Edwards (COL, San Antonio Military Medical Center)
Background: The San Antonio Military Medical Center (SAMMC) is completely run, organized
and funded by the United States Military. The Medical Center has been caring for civilian trauma
patients since organized trauma has been present within the city of San Antonio. In 1977, three
years after the end of Vietnam War, SAMMC embarked on an official relationship with the city to
care for civilian trauma patients. Over the past 40 years the Medical Center has been recognized
as a center for innovation in the care of the trauma patient. This bidirectional flow of information
between the civilian and military has resulted in national attention in the recently published, feder-
ally funded, document: “A National Trauma Care System: Integrating Military and Civilian Trauma
Systems to Achieve Zero Preventable Deaths After Injury”
Learning Objentives:
1. Overview of the military and civilian successes that have been contributed to include
a. Defining preventable trauma deaths
b. Joint Trauma Theater System/Regional Trauma Center
c. Whole blood transfusions and 1:1:1 Massive transfusions
d. Clinical Practice Guidelines
e. Critical Care Air Transport
f. Tourniquets
g. Damage Control Resuscitation and Surgery
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The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
2. Overview of the challenges of military hospital caring for civilian trauma patients to include
a. Using military funds to care for civilian trauma patients
b. Staffing a busy trauma center with military personnel during war
3. Brief overview of the National Trauma Care system as it applies to SAMMC
Conclusion: SAMMC’s military organization and unified structure along with its clarity of mis-
sion when caring for a combat casualties partnered with the civilian communities constant and de-
manding need for trauma care provides a symbiotic relationship that has been successful enough
to contribute to the model for a national trauma care system.
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Namyeol Kim (Korea Univ. Hospital)
Moderator
Jung Nam Lee (Gachon Univ. Gil Hospital)
Jungchul Kim (Chonnam National Univ. Hospital)
1F. Main Auditorium
Symposium 5
Trauma Management Update
06-24 (Sat.), 2017
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1991. 3 ~ 1999. 2: B.D., College of Medicine, Pusan National University, Busan, Korea
2002. 3 ~ 2004. 2: M.D., Postgraduate School of Medicine, Pusan National University,
Busan, Korea
2010. 3 ~ 2012. 2: Doctor's Course, Postgraduate School of Medicine, Pusan National
University, Busan, Korea
2000. 3 ~ 2001. 2: Internship, Pusan National University Hospital, Busan, Korea
2001. 3 ~ 2005. 2: Residency, Department of Surgery, Pusan National University
Hospital, Busan, Korea
2008. 5 ~ 2009. 2: Fellowship, Department of Surgery, Pusan National University
Hospital, Busan, Korea
2009. 3 ~ Present: Assistant Professor, Pusan National University Hospital, Busan,
Korea
2012. 3 ~ 2016. 3: Divisional Director of Trauma Program, Trauma Center, Pusan
National University Hospital, Busan, Korea
2014. 6 ~ Present: Chief, Department of Trauma and Durgical Critical Care, Pusan
National University Hospital, Busan, Korea
Member, Korean Surgical Society
Executive member, Korean Society of Acute Care Surgery
Member, Korean Society of Critical Care Medicine
Member, Korean Society of Traumatology
Educational
Background
Post-Doctoral
Training Including
Residency/
Fellowship
Hospital
Positions
Membership
Symposium 5 - Trauma Management Update
Jae Hun Kim (Pusan National Univ. Hospital)
163
Symposium 5 - Trauma Management Update
Should TEG/ROTEM be a Standard of
Trauma Care?
Jae Hun Kim (Pusan National Univ. Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
Models of coagulation and limitations of standard coagulation tests
Coagulation is a complex, dynamic, highly regulated and interwoven process involving a myriad
of cells, molecules and structures. The model of coagulation that was conventionally taught was
the cascade model of a series of proteolytic reactions that act as a biological amplifier.
By Dr Graham Beards
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The 32nd Annual Meeting of the Korean Society of Traumatology
However, the limitations of this model of the hemostatic process become clear in clinical
situations. The intrinsic and extrinsic pathways cannot be operating as independent, redundant
pathways in vivo and it was also recognized that cells are important participants in this process,
and that normal hemostasis requires cell associated tissue factor (TF) and platelets, in addition to
the proteins of the coagulation cascade.
So, new model of coagulation was proposed in 2001 by Hoffman and Munroe, and has become
the accepted description of how hemostasis takes place in vivo. The cell base model proposes that
hemostasis occurs in three distinct, but overlapping steps - initiation, amplification and propagation.
BSAVA Manual of Canine and Feline Clinical Pathology, 3rd edition
The activated partial thromboplastin time (aPTT) and prothrombin time (PT) are the most
commonly used tests of coagulation. The aPTT is used to assess the contact activation and the
integrity of the intrinsic coagulation pathway (factors XII, XI, IX and VIII) and final common
pathway (factor II(prothrombin), V,X and fibrinogen). The PT is used to assess the integrity of the
extrinsic pathway, which consists of TF and VIIa, and coagulation factors of the common pathway.
As mentioned before, in vivo the coagulation reactions occur on specific cell surfaces, rather
than on phospholipid surfaces as they do in the PT and aPTT assays. So, in many studies, standard
coagulation tests cannot reflect the coagulopathy.
Coagulopathy in trauma
Recently, the unique changes in coagulation caused by trauma are starting to be understood, but
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it is very complex and remains mostly unknown.
By Hess et al.
Trauma patients with coagulopathy are the largest consumers of blood and blood products and
the decision of what, when and how much blood and blood product to transfuse is often empiric
or based on traditional coagulation lab tests such as INR/PT, PTT and platelet count. Any delay in
obtaining the lab results can lead to inadequate transfusion and increased morbidity and mortality.
Thus in trauma, global, functional and immediately available laboratorial evaluation of hemostasis
can improve both patient management and outcome.
Viscoelastic tests of coagulation (TEG/ROTEM)
Viscoelastic coagulation tests have a chance to overcome many of the limitations of conventional
coagulation tests, as they measure the entire coagulation process, from fibrin formation through
to final clot strengthening and fibrinolysis. It provides a global and functional assessment of
coagulation. In addition, the faster availability of results may assist clinical decisions of what, when
and how much blood and products to transfuse.
The two tests have the same foundational principles and share many similarities, from hardware
(equipment) and procedures (technique) to tracing (graph) and parameters, equivalent with
interchangeable results and interpretations.
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By Sankarankutty et al.
The studies on TEG- or ROTEM-based transfusion algorithms suggested that while both tests can
be used to construct transfusion guidelines, the blood products transfused differ according to the
algorithm selected. Therefore, a standardized guideline for this is needed.
Conclusion
TEG and ROTEM have many of the characteristics of ideal tests for use in trauma including
global evaluation of coagulation, both quantitative and functional assessment. TEG and ROTEM
could have important roles in trauma in 3 ways: by promptly diagnosing early trauma coagulopathy
(diagnostic tools); guiding blood transfusion and revealing patients’ prognosis. But, their potential
clinical utility must be balanced against limitations particularly the considerable heterogeneity in
methods, reagents and parameters evaluated.
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Dr. Lee entered the School of Medicine, Ajou University, in March 1988 and graduated from the same with a
BA degree in medicine in February, 1995. He entered Graduate School of medicine, Ajou University, in March,
1997, was awarded a Master degree in Medicine, 1999, and a Ph.D. degree in Medicine, 2002. He completed
a 1-year internship course on Ajou University Hospital, 1995 and 4-year residency course in Department
of General Surgery, Ajou University Hospital, 1996 - 2000. He received special training from the San Diego
Microsurgical institute & Training Center at Mercy Hospital La Jolla, California, U.S.A., in October, 1997 and
Trauma Center of UC San Diego Medical Center, Hillcrest San Diego, California, U.S.A., in January, 2003.
He did his Fellowship Training in General Surgery in 2001 and Trauma Surgery in 2002. Dr. Lee enlisted in
the Republic of Korea Navy in March, 1992 and was discharged from service and placed on the reserve list
afterwards.
He was employed as a faculty member of Ajou University Medical Center & School of Medicine as an
instructor in September, 2002 and promoted to be an Assistant Professor of Ajou University Medical Center
& School of Medicine in September, 2004. He worked at the Royal London Hospital in the United Kingdom as
an Honoary Consultant Trauma Surgeon from 2007 to 2008.
Dr. Lee has received numerous awards, including the 2010 Recognition in National Emergency Medical
System by Ministry of Health and Welfare, and Civil Merit Medal in 2011 for his devotion to a Trauma Care
System in South Korea.
Dr. Lee was awarded certificate of appreciation two times from White House Medical Unit of the United
States in 2009 and 2010 due his outstanding support for the US troops stationed in South Korea and lots of
American Citizens.
Symposium 5 - Trauma Management Update
John Cook-Jong Lee (Ajou Univ. Hospital)
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Symposium 5 - Trauma Management Update
Retrohepatic Vena Cava Injury
John Cook-Jong Lee (Ajou Univ. Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
Traumatic injury to the retrohepatic veins continues to carry high mortality rates. In the last few
decades various management strategies have been proposed. However, treatment of such injuries
still remains highly variable and technically challenging due to the surgically inaccessible location
of these vessels and the consequent difficulty controlling bleeding.[1] Massive hemorrhage on the
vena cava is a major obstacle to repair. Also, damage to the hepatic veins can be extraparenchymal
or intraparenchymal.[2] Life-threatening bleeding from these injuries occurs if the supporting struc-
tures, mainly the suspensory ligaments, diaphragm, or liver parenchyma, are disrupted. Therefore,
the exposure of a major venous injury may release the tamponade and result in free bleeding and
exsanguination. As Buckman et al. outlined, there are three main strategies described to deal with
these mortal injuries. The first is to directly repair te venous injury with or without vascular isola-
tion. The second is with a lobar resection. The third is by using a strategy of tamponade and con-
tainment of the venous bleeding.
Direct venous repair
Schrock et al. first introduced the atriocaval shunt in 1968. The goal is to shunt the blood from
the infrahepatic vena cava, bypassing the retrohepatic cava, and directing flow into the artia. This
along with the Pringle maneuver, is theoretically used to creat a bloodless field. Unfortunately, of
the approximately 200 cases published using atriocaval shunting, only at best 10-30% survive their
injury. Shunting a patient cannot be successfully accomplished if the patient has already had major
blood loss, becomes coagulopathic, and has inadequate operative incisional exposure.
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In our case, 42 years old, male with penetrating injury on the junction of retrohepatic IVC and
hepatic vein injury was successully treated with direct venous repair. We use venovenous bypass
from Rt fimoral vein to Rt. Artria with Pringle maneuver.
However, in two more cases, we were failed with direct venous repair. They were blunt trauma
patients. All of them already had severe exsanguination and coagulopathy with massive tearing of
vena cava with other organ injury including liver.
Anatomic resection
Anatomic resection has resulted in a high mortality when carried out for traumatic bleeding. In
certain circumstances when the dissection has already been done by the injury itself, resection for
debridement may be indicated. However, current data do not promote anatomic resection for ma-
jor venous injury unless direct repair is necessary.
Tamponade with containment
The focus on severe vascular injury management has shift to methods of tamponading and con-
taining venous injury in addition to embolization of arterial bleeding. At this time it seems that the
most successul method of managing severe retrohepatic or hepatic venous injury is by using tam-
ponade and containment. Direct repair of damaged vessels continues to have a very high morbidi-
ty even in the most experienced hands. Overall, the best approach to severe liver injury includes
(a) Expedient recongnition and operative intervention of unstable hemorrhaging patients,
(b) Mibilization of the liver ligaments not directly involved with hematoma to better visual-
ize the injury
(c) Placement of a viable omental tongue into parenchymal defect
(d) Rapid determination of the need for gauze packing when direct surgical maneuvers fail
(e) Angiographic embolization of hepatic arterial injured branches when ongoing hemor-
rhage or CT blush is seen[3]
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1. Kaoutzanis, C., et al., Successful repair of injured hepatic veins and inferior vena cava following
blunt traumatic injury, by using cardiopulmonary bypass and hypothermic circulatory arrest.
Interact Cardiovasc Thorac Surg, 2011. 12(1): p. 84-6.
2. Biffl, Walter L. MD; Moore, Ernest E. MD; Franciose, Reginald J. MD, Venovenous Bypass and
Hepatic Vascular Isolation as Adjuncts in the Repair of Destructive Wounds to the Retrohepatic
Inferior Vena Cava
3. Kenneth L. Mattox, Ernest E. Moore, David V. Feliciano, Trauma, 7th Edition, Mcgraw
hill:p.552-554
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
1993 - 1999 Graduate from Catholic University College of Medicine, Bachelor
2001 - 2003 Graduate school of Medical Science, Catholic University College of
Medicine (Master Degree)
2010 - 2013 Graduate school of Medical Science, Catholic University College of
Medicine (Ph.D)
1999 Internship, Holy Family Hospital, The Catholic University of Korea
2000-2004 Residentship in General Surgery, Catholic Medical Center, Korea
2004-2007 Captain, Republic of Korea(ROK) Army
2006-2007 Chief of Medical Staff, Zaytun Hospital, Iraq, ROK army
2007-2010 Fellowship in General Surgery, Uijeongbu St. Mary Hospital
2010-2012 Clinical Assistant Professor in Trauma Surgery, Uijeongbu St.
Mary’s Hospital
2011-Now Subspecialist, Critical Care Medicine
2012-Now Subspecialist, Trauma Surgery
2013-Now Assistant Professor in Division of Trauma Surgery, Uijeongbu St.
Mary’s Hospital
2013-Now Director, Committee on information, The Korean Society of
Traumatology
2013-Now Director, Committee on information, The Korean Society of Acute
Care Surgery
2015-Now Assistant Administrator, The Korean Surgical Ultrasound Society
2015-Now Director, Department of Trauma Surgery
2015-Now Director, Regional Trauma Center, North Kyunggi Province
Education
Professional
Experience
Symposium 5 - Trauma Management Update
Hang Joo Cho ( The Catholic Univ. Hospital)
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Open or Closed? The MIS Applied to Trauma
Hang Joo Cho ( The Catholic Univ. Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
Minimally invasive surgery(MIS) is now widely used in all surgical field except for trauma sur-
gery. This is because MIS have several disadvantage including increased possibility of missed injury
& bowel injury, increased IICP, more time consuming, greater chance of gas embolism. If missed
injuries were occurred or time to bleeding control is delayed, the patient’s survival was threatened.
However,MIS have extinguished benefits including improved cosmesis, low tissue desiccation,
lower chance of post-operative paralytic ileus and so on.
Laparoscopic trauma surgery(LTS) is devided into two classes, diagnostic & therapeutic.
Diagnostic laparoscopy
Diagnostic laparoscopy is used for sparing non therapeutic laparotomy. Especially in cases with
abdominal stab wound with proven or equivocal penetration of fascia, suspected intraabdominal
injury after blunt trauma, diagnosis of diaphragmatic injury from penetrating trauma to the thora-
coabdominal area. Sensitivity, specificity, diagnostic accuracy of diagnostic laparoscopy range from
75% to 100%.
Therapeutic laparoscopy
Laparoscopic repairs of injuries to every organ have been described. Injuries to diaphragm,
parenchyma organ and gastro-intestinal tract have been successfully repaired laparoscopically.
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Patients who continue to bleed following embolization can be treated with laparoscopy by topical
hemostatic agent or even splenectomy. Small laceration of stomach, duodenum, small bowel, co-
lon can be repaired laparoscopically. Sometimes an anastomosis or a long repair are usually per-
formed extracorporeally through a small focused celiotomy. Diaphragmatic hernia(esp. Lt.) can be
repaired successfully by various laparoscopic suture techniques.
Contraindication
Hemodynamic instability is currently the absolute contraindication for laparoscopy. Concomitant
severe traumatic brain injury also exclude laparoscopy because of increased intracranial pressure
Conclusion
Position of laparoscopic surgery in trauma field is between laparotomy and observation. Be-
cause of innovative development of laparoscopic instruments, almost all surgery can be conducted
by laparoscopic method. Role of laparoscopy in trauma will be increased also in trauma surgery. If
the patient’s vital sign is stable, laparoscopic methods can be applied, however we should be care-
ful about missed injury.
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Symposium 5 - Trauma Management Update
Namyeol Kim (Korea Univ. Hospital)
2002.2 : Master, Korea University of Graduate School (Medicine)
2005.2 : Doctor, Korea University of Graduate School (Medicine)
2016.2 ~ : Head of Critical Care Department at Korea University Guro Hospital
2016.7 ~ : Board Member of Korean Surgical Infection Society
2014.4 ~ 2014.5 : Trauma Surgeon, Agok MSF Trauma Hospital, South Sudan
2014.3 ~ : Manager of Trauma Surgery at Korea University Guro Hospital
2014.3 ~ : Board Member of MEDICINS SANS FRONTIERES KOREA
2013.6 ~ : Director, Korea Disaster Surgical Response Team
2014.3 ~ 2016.3 : Board Member of MEDICINS SANS FRONTIERES JAPAN
2013.3 ~ : Associate Professor of General Surgery at Korea University Guro Hospital
2011.10 ~ 2012.11 : Manager of Trauma surgery at Cheju Halla General Hospital
2011.1 ~ 2011.5 : Field Medical Doctor / Medical Consultant in MSF-CH Yanbian
2010.10 ~ 2010.11 : Trauma Surgeon, Hangu MSF Trauma Hospital, Pakistan
Education
Qualification &
Experience
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Symposium 5 - Trauma Management Update
Damage Control Surgery.
Light and Dark Side
Namyeol Kim (Korea Univ. Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Oh Hyun Kim (Yonsei Univ. Wonju College of Medicine)
Moderator
Il Ung Hwang (Former Commanding General, Armed Forces Medical Command, ROK)
Young-Rock Ha (Bundang Jesaeng Hospital)
1F. Main Auditorium
Symposium 8
Trauma US
06-24 (Sat.), 2017
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Symposium 8 - Trauma US
Hang Joo Cho ( The Catholic Univ. Hospital)
1993 - 1999 Graduate from Catholic University College of Medicine, Bachelor
2001 - 2003 Graduate school of Medical Science, Catholic University College of
Medicine (Master Degree)
2010 - 2013 Graduate school of Medical Science, Catholic University College of
Medicine (Ph.D)
1999 Internship, Holy Family Hospital, The Catholic University of Korea
2000-2004 Residentship in General Surgery, Catholic Medical Center, Korea
2004-2007 Captain, Republic of Korea(ROK) Army
2006-2007 Chief of Medical Staff, Zaytun Hospital, Iraq, ROK army
2007-2010 Fellowship in General Surgery, Uijeongbu St. Mary Hospital
2010-2012 Clinical Assistant Professor in Trauma Surgery, Uijeongbu St.
Mary’s Hospital
2011-Now Subspecialist, Critical Care Medicine
2012-Now Subspecialist, Trauma Surgery
2013-Now Assistant Professor in Division of Trauma Surgery, Uijeongbu St.
Mary’s Hospital
2013-Now Director, Committee on information, The Korean Society of
Traumatology
2013-Now Director, Committee on information, The Korean Society of Acute
Care Surgery
2015-Now Assistant Administrator, The Korean Surgical Ultrasound Society
2015-Now Director, Department of Trauma Surgery
2015-Now Director, Regional Trauma Center, North Kyunggi Province
Education
Professional
Experience
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Symposium 8 - Trauma US
Recent Updates in FAST from the Perspective
of a Trauma Surgeon
Hang Joo Cho ( The Catholic Univ. Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
FAST (Focused Assessment with Sonography for Trauma)란 외상환자에게 초음파 검사를 시행
하여 흉복부 손상을 빠르게 진단하는 초음파 진단법이다. 초창기에는 복강 내 저류액의 유무를 확인
하기 위하여 시행하였다. 1996년 Focused Abdominal sonogram for trauma를 FAST로 기술하였다
가 1999년 국제합의회의를 통하여 복강 내 장기에만 국한되지 않는 것을 고려하여 Focused Assess-
ment with sonography for trauma로 이름을 바꾸었다. 복부와 심장검사에 기흉의 진단을 추가하여
eFAST(extended FAST)를 시행하기도 한다. FAST 검사는 ATLS(Advanced Trauma Life Support)중
에 주로 시행되며 중증외상환자의 치료에 선봉에 서 있는 외상외과 의사에게는 상당히 중요한 검사
법이다. FAST는 최소 4군데의 검사가 필요하다. 곡선형 탐촉자를 이용하여 1) 검상하, 2) 우상복부
3)좌상복부 4) 골반 의 순서로 검사를 시행하며 심장과 복강내에 혈액의 유무를 판단하게 된다.
먼저 심장막 구역에서는 검상하 영상으로 확인을 하게 되며, 심장에 있는 혈액을 기준으로 게인
을 조절한다. 만약 검상하 영상으로 심장이 잘 보이지 않는다면 부흉골 장축, 단축영상과 4 chamber
view를 통해서라도 심장은 반드시 확인한다.
두 번째로는 우상복부의 모리슨 궁의 혈액의 저류를 확인하는데 간이나 비장 손상시에 가장 먼저
혈액이 고이는 곳이 우상복부이기에 맨 처음 확인하게 된다. 우측 11-12번 늑간을 활용하여 탐촉자
를 위치시켜 간, 신장, 횡격막의 단면을 얻게 된다.
세 번째로는 좌상복부의 횡격막하 공간과 비장과 신장사이의 공간에 혈액의 저류를 확인한다. 중
요한 것은 우상복부보다 조금더 머리쪽으로 그리고 뒤쪽으로 탐촉자를 위치시켜야만 잘 관찰이 된
다는 것이다.
마지막으로 골반의 더글라스 궁을 관찰하는데 종축과 횡축 두 가지로 관찰하게 된다. 먼저 횡축
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The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
영상으로 치골결합의 머리 방향으로 약 4cm 떨어진 곳에서 시작하여 꼬리쪽으로 탐촉자를 내려오
게 하면서 골반강내 액체의 저류를 확인한다. 이 때 방광이 차 있으면 더 좋은 영상을 얻을 수 있기에
foley catheter 삽입 전에 시행하면 좋다. 다시 탐촉자를 90도로 돌려 종축영상을 확인한다.
FAST는 외상외과 의사가 직접 수행함으로서 초음파 검사의 장점을 극대화 할 수 있다. 외상환자
는 최종치료까지의 시간이 1시간 이내를 목표로 하기에 환자가 혈역학적으로 불안정하며 초음파에
서 복강내 출혈이 의심이 된다면 CT 등의 추가 검사 없이 바로 수술실로 향하게 된다.
단점으로는 어떠한 장기가 손상을 받았는지 정확히 모른다는 것이다. 기존의 다기관 연구에서 고
형장기의 손상을 진단할 수 있는가에 대하여 연구하였는데 장기가 얼마나 다쳤는지에 따라서 달라
지겠지만 민감도는 25-75% 정도이며, 시간이 훨씬 더 소요되므로 아직까지 효용성은 떨어지는 것으
로 판단한다.
최근에는 E-FAST에서 더 나아가 흉부에서 pneumothorax뿐아니라 hemothorax, lung contusion
을 진단할 수도 있으며 primary resuscitation인 ABCDE에서 초음파가 모두 유용하며 사용되어야 한
다고도 보고되고 있다.
결론적으로 외상환자의 최종치료까지의 시간을 줄이는 데 없어서는 안될 가장 중요한 검사 수단
으로서 처음에는 복부의 free fluid의 저류를 진단하는 것에서 더 나아가 일차 소생에서의 모든 응급
질환을 감별하는 수단 및 특히 shock인 환자에서 원인을 진단하는데 까지 점점 더 확대되고 있다.
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Symposium 8 - Trauma US
Han-Ho Do (Dongguk Univ. Ilsan Hospital)
Emergency physician, M.D., Ph.D.
Associate Professor in Dongguk University College of Medicine
Executive Director of Society of Emergency and Critical Care Imaging
Member of the Korean Society of Emergency Medicine
International Ultrasound Instructor of Winfocus
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Ultrasound Guided Procedure of Central
Venous Catheterization (CVC)
Han-Ho Do (Dongguk Univ. Ilsan Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
1. Pre-procedure ultrasound (US) scan
A. Pre-scan of central vein
- Vessel patency, thrombosis
B. Pre-scan of Lung
- Confirming proper pleural attachment in the ipsilateral anterior chest wall
- Lung sliding sign or lung pulse
2. Ultrasound guided procedure
A. USG venous puncture
- dynamic scan, longitudinal view
B. USG guidewire confirmation
- Scan distal IJV just above clavicle
3. Post-procedure US confirm
A. Lung scan for pneumothorax
- Check for no lung sliding, lung point
B. Right heart scan with contrast
- Microbubble appearance within 1 second (proper tip position)
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Table 1. Checklist of SECURE protocol
Checklist
1st STEP
Pre-scan of
internal jugular vein
Scan the internal jugular vein □ Completed □ Not
Vein sit on artery anteriorly
Narrowing or thrombus inside
□ Head rotation
□ Quit protocol
2nd STEP
Pre-scan of pleura
Scan ipsilateral anterior pleura □ Completed □ Not
Lung sliding sign
Lung pulse
□ Attached pleura
□ Attached pleura
3rd STEP
Ultrasound guided
internal jugular vein
puncture
Scan the needle tip penetrating □ Completed □ Not
Needle tip in jugular vein
Arterial puncture
Arterial hematoma
Vessel injury
□ Insert guidewire
□ Compression
□ Quit protocol
□ Quit protocol
4th STEP
Guidewire scan
Scan jugular vein above clavicle □ Completed □ Not
Guidewire inside the jugular vein
Arterial inserted guidewire
Invisible guidewire
Vessel injury
□ Insert expander
□ Remove guidewire
□ Neck vessel scan
□ Quit protocol
5th STEP
Post-scan of pleura
Scan anterior pleura, again □ Completed □ Not
Preserved lung sliding or pulse
Loss of lung sliding
Loss of lung pulse
□ No pneumothorax
□ Pneumothorax
□ Pneumothorax
6th STEP
Post-scan of heart
Scan right side heart □ Completed □ Not
Push-to-bubble time > 1 second □ Catheter malposition
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The 5th Pan Pacific Trauma Congress
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Fig. 1 (A) Pre-scan of internal jugular vein. (B) Pre-scan of pleura, (C) Ultrasound guided vein puncture, (D) Guide-
wire scan, (E) Post-scan of pleura, (F) Post-scan of heart with agitated saline.
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Symposium 8 - Trauma US
Bo Seung Kang (Hanyang Univ. Guri Hospital)
B.A. Hanyang University, 1996 (Medical school)
Board certification of Emergency Medicine, Samsung Seoul Hospital, 2001
2013-Current, Associate Professor of Medical School, Hanyang University
2007-2012, Assistant Professor of Medical School, Hanyang University
2011-2015, President of Korean Academy of Emergency Cardiovascular Care
2013-Current, Educational Chair, Society of Emergency Critical Care Imaging
Moderate Alcohol Consumption & Health Beneficial Effect
Aldehyde Dehydrogenase 2 & Related Genetic Polymorphism
Emergency Ultrasound,Telemedicine and Telecare
Emergency Cardiovascular Care
Education
Professional
Experience
Academic Service
Research Interest
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Symposium 8 - Trauma US
The Role of POCUS in Cardiovascular
Trauma
Bo Seung Kang (Hanyang Univ. Guri Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
The Role of POCUS in Cardiovascular Trauma
Bossng Kang Emergency Medicine
Hanyang University Guri Hosp Gyunggi, Korea
Diagnosis & USG Procedure• Thoracic Aorta Trauma (isthmus)• Pericardial effusion (bleeding)• Cardiac Tamponade
• early diastolic RV collapse
• USG Pericardiocentesis• apical/ parasternal approach
Diagnosis• Injury of Myocardial Walls
• RV(>>LV) non-Coronary RWMA• Dilatation of Chamber (RV)• Thrombus within Dysfunctional Chamber• Atrial Rupture (>> Ventricular)
• Stress induced CMP• Tricuspid Valve Trauma (chordae rupture)
first, pericardial effusion confirmed ?
Patient selection using Echo
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5
early diastolic RV collapse
Pericardiocentesis required ?
7
Blind subcostal approachtraditional method
Less frequently used, depending on the 2D Echo finding
- Trauma: liver, heart(CA), lung - High complication rate - long pathway
Tamponade finding detection not easy w fast HR
Who needs
emergency pericardiocentesis ? - appropriate patient selection –
• Obvious tamponade finding w severe symptom or low B.P.
or Cardiac arrest
Ideal site for needle entry
Mark
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The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
Mark Ideal site for needle entry Apical approach
Symposium 8 - Trauma US
Young-Rock Ha (Bundang Jesaeng Hospital)
Certified Emergency Physician (KSEM)
Certified Critical Care Physician (KSCCM)
Certified Physician for Echocardiography (KSECHO)
Adjunct Professor of Dept of EMT in Dongnam Health College
Adjunct Professor of Dept of EM in Yosei University Medical College
President, Society of Emergency and Critical Care Imaging (SECCI)
Board of Director, Korean Society of Critical Care Medicine (KSCCM)
Faculty and Instructor, Essential Surgical Procedures in Trauma (ESPIT) in Korea
Board of Director, WINFOCUS (World Interactive Network of Focused on Critical Ultrasound)
Faculty and Instructor, USLS BL1P, USLS AL1P, WBE, WMTBE and WBLUS of WINFOUCS
International Faulty of AACES in Singapore
Director of SEARCH 9Es Course in Korea
US Chapter Author of the Korean Text Books of Trauma and Critical care medicine
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The Role of Lung US in Trauma
Young-Rock Ha (Bundang Jesaeng Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
POC LUNG ULTRASOUND IN TRAUMA
Dr. YOUNG-ROCK HA. Dept. EM. BUNDANG JESAENG HOSPITALPRESIDENT, Society of Emergency and Critical Care Imaging (SECCI)
ABC OF LUNG ULTRASOUND
OUTLINE
ABC of lung ultrasound
Traumatic pneumothorax
Traumatic hemothorax
Traumatic lung contusion
PROBE FOR A LUNG US
Equipment• Microconvex Probe 4-7 MHz• Curvilinear Probe 2-6 MHz• Any probe depending on the focus.
Settings• Marker to left of screen• No harmonics
Technique• Patient in supine position• Longitudinal plane• Probe perpendicular to chest wall
4-7 MHz
2-6 MHz
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How to scan the lung
Longitudinally and perpendicularly
HOW TO INTERPRET IT IN A SINGLE SCAN?
Pleural line
Chest wall
Sub-pleural space
Lung sliding, lung point, lung pulse, pleural abnormality
A-lines, B-lines, Consolidation, Effusion
Sternum
Anterior Axillary
12
34
Posterior
Axillary
56
Complete evaluation of both lungs• Locate the diaphragm• Divided 6 regions in each chest• Every intercostal spaces
COMPREHENSIVE LUS
Crit Care Med 2010;38:84 –92
FIND THE “BAT SIGN’ IN STEP 1.
• Visible only in longitudinal scan• Mandatory first sign to acquire• Permanent landmark of the lung surface
Lower ribUpper rib
* *
HOW MANY POINTS?6 points: BLUE 10 points 14 points
Kristensen Insights Imaging 2014Lichtenstein Chest 2008 Segikuchi Chest 2015
Normal lung pattern: APleural line and lung sliding
A-pattern
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NORMAL LUNG2D & M-MODE
2D• Lung sliding• A lines
M-mode• Seashore sign
Transducer
Multiple US Beam Reflections
NORMAL INTERLOBULAR
SEPTAHOMOGENEOUS
TISSUE-AIR INTERFACE
REVERBERATIONS
NORMAL ARTIFACTS (A lines)
B-pattern
Abnormal lung pattern: B
Interstitial syndrome in trauma =lung contusion
C-pattern
Abnormal lung pattern: C
Alveolar consolidation in trauma = lung contusion
A’-pattern
Abnormal lung pattern: A’
pneumothorax
Transducer
Multiple US Beam Reflections
NORMAL INTERLOBULAR
SEPTAHOMOGENEOUS
TISSUE-AIR INTERFACE
Transducer
THICKENED INTERLOBULAR
SEPTA
Multiple US Beam Reflections
INHOMOGENEOUS TISSUE-AIR INTERFACE
REVERBERATIONS
COMET TAILS (B lines)
REVERBERATIONS
NORMAL ARTIFACTS (A lines)
LUNG US ACCORDING TO THE AIR-TO-FLUID RATIO
Traumatic PNX Lung contusion HPX
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LUNG
DIAGNOSTIC POWER OF LUNG US IN TRAUMA
VISCERAL PLEURA
PARIETAL PLEURA
PLEURAL CAVITY
EVLWVariable Air/fluid
Lung contusion
Pure Air in pleural cavity
pneumothorax
Pure Fluid in pleural cavity
Hemothorax
J Trauma. 2004;57:288–295.
TRAUMATIC PNEUMOTHORAX
abdo
menlung
Normal Lung
Collapsed lung
PNEUMOTHORAX
abdo
men
TISSUE-AIR INTERFACE
Absence of lung sliding
Absence of pathological artifacts arising from pleural line =
No B-lines/ No consolidation/ No lung pulse
ABSENCE OF THE LUNG BENEATH THE PLEURA (in the explored area)
PNEUMOTHORAX
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A’-pattern
Abnormal lung pattern: A’
pneumothorax
LUNG POINT
OCCULT PNEUMOTHORAX
Anatomical distribution of traumatic occult pneumothoraces
Mennicke et al. Am J Emerg Med 2012
Normal PatternPNEUMOTHORAX
Seashore sign
TENSION PNEUMOTHORAX
Can’t and need not to find out the lung point!
Needle thoracotomy!
F/50 Fall down Occult pneumothorax
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The 5th Pan Pacific Trauma Congress
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AACES.SG
Pitfall: Subcutaneous emphysema
SUBCUTANEOUS EMPHYSEMA
USSEN 83%SPE 98%
CXRSEN 25.5%SPE 95%
THE SINUSOID SIGN
HEMOTHORAX
THE QUAD SIGN
AACES.SG
THE SPINE SIGN
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The 5th Pan Pacific Trauma Congress
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AACES.SG
HOMOGENOUSLY ECHOGENIC
abdo
menlung
Pleural Effusion Pleural Effusion
lung
90°
DETECTION
LUNG CONTUSION
M/39 FELL DOWN FROM 30 M HIGH. 80/60, 115/M
Vignon P, CRIT CARE 2005.
Roch A, CHEST 2005
End Expiratory IP Distance 5th intercostal space > 50 mm
> 500 ml
End Expiratory Basal IP Distance > 45 mm (Rt)
> 50 mm (Lt)> 800 ml
INTERPLEURAL DISTANCE
lung
SEMI-QUANTITATIVE ASSESSMENT
LUNG CONTUSION
Sonographic definition of lung contusion(a) consolidation: a moderately hypoechoic blurred lesion whose dimensions remained unchanged during the inspiration phase.(b) B lines: multiple (at least three) vertical hyperechogenic lines arising from pleural line.• B lines are a early sign of lung contusion which is not visible on
chest X-ray.
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FOCAL (LOCALIZED) INTERSTITIAL SYNDROME
Pneumonia and pneumonitisAtelectasisPulmonary contusionPulmonary infarctionPleural diseaseNeoplasia
Intensive Care Med. 2012;38(4):577–91.
CAUSES OF LUNG CONSOLIDATIONS
• Infection• Pulmonary embolism• Lung cancer and metastasis• Compression atelectasis• Obstructive atelectasis• Lung contusion
Intensive Care Med. 2012;38(4):577–91.
The shred line: irregular border connected with aerated lung
SHRED SIGN
Irregularly spaced B lines Closely spaced B lines
Coalescent B lines Consolidation
Lung contusion along to the severity of aeration loss
Yang PC. AM REV RESPIR DIS 1992; Lichtenstein DA. INT CARE MED 2004
• Alveolar consolidation: echo-poor or tissue- like pattern• Located at thoracic level• Anatomic boundaries: regular upper border (pleural line or PE),
irregular (shred sign, aerated lung) or regular (lobar pneumonia) lower border
• ± Air broncograms (true consolidation / atelectasis)
‘HEPATIZATION’ OF LUNG PARENCHYMA
12 studies were included in this meta-analysis (1681 chest trauma patients, 76% male).
US: SEN 0.92 (95% CI: 0.81-0.96)SPE 0.89 (95% CI: 0.85-0.93)
Chest radiography: SEN 0.44 (95% CI: 0.32-0.58) SPE 0.98 (95% CI: 0.88-1.0)
Emergency. 2015;3(4):127-34.
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THE ANATOMOPATHOLOGICEVOLUTION OF THE LUNG CONTUSION: 3 PHASES1. The trauma itself, which determines a hemorrhagic or
lacerated core by direct energy transfer to the lung parenchyma
2. An edematous phase, with a progressive infiltrate of the interstice within 1 to 2 h after the primary injury
3. A Consolidation phase: Flooding of air spaces with blood, inflammatory cells, and tissue debris. This consolidation is maximal at 24 to 48 h after the primary injury.
• The conventional CXR can only detect contusion in the third phase, when a confluent consolidation is established.
LUS score in each area:0 = no contusion in the area, 1 = contusion in a part of the area, 2 = contusion in the whole area.
LUNG US IN TRAUMA
FAST
E-FAST
CA-FAST
PNEUMOTHORAX
HEMOTHORAXLUNG CONTUSION
Eur J Trauma Emerg Surg (2015)
A LUS score of 6 was identified as the best threshold value
Cumulative categories of ARDS: severe (PaO2/FiO2 ≤ 100 mmHg), severe to moderate (PaO2/FiO2 ≤ 200 mmHg), severe to mild (PaO2/FiO2 ≤ 300 mmHg)
TAKE HOME MESSAGE• In the setting of acute injury, ultrasound enhances the basic
trauma evaluation, influences bedside decision-making, and helps determine whether or not an unstable patient requires emergent procedural intervention.
• Lung ultrasound allows better diagnostic performance in detection of pneumothorax, hemothorax, and lung contusions compared to bedside chest radiography.
• Lung contusion extent assessed by LUS on admission identifies patients at risk of developing ARDS within 72 h after a severe blunt trauma.
• Chest-Abdominal FAST should be used as initial investigation during the primary survey and management.
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Kang-Hyun Lee (Yonsei Univ. Wonju College of Medicine)
Moderator
Hyun-min Cho (Pusan National Univ. Hospital)
Keum Seok Bae (Yonsei Univ. Wonju College of Medicine)
1F. Main Auditorium
Symposium 10 (KR)
Current of Trauma Center :Still Much to be Improved
06-24 (Sat.), 2017
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Symposium 10 (KR) - Current of Trauma Center : Still Much to be Improved
Hyun-min Cho (Pusan National Univ. Hospital)
Medical College, Yonsei University (MB)
Graduate school of Medicine, Seoul National University (ABD)
Life Member of The Korean Society of Traumatology
Life Member of The Korean Society for Thoracic & Cardiovascular Surgery
2003.03 - 2011.02 : Assistant Professor, Department of Thoracic & Cardiovascular
Surgery (Konyang Univesity Hospital, Daejeon, Korea)
2011.03 - 2013.11 : Associate Professor, Department of Thoracic & Cardiovascular
Surgery (Konyang Univesity Hospital, Daejeon, Korea)
2013.12 - 2014.04 : Associate Professor
2014.04 - Present : Fund Professor
2015.03 - Present : Director of Trauma Center, Pusan National University Hospital,
Busan, Korea
2013.06 - Present : Secretary General, The 2nd & 3rd PPTC
2014.03 - Present : Councilor of KARPET(Korean Association of Research, Procedure
and Education on Trauma) Faculty of ESPIT(Essential Surgical
Procedures In Trauma)
2014.09 - Present : Director of BESPIT
Academic
Background
Work
Experience
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Symposium 10 (KR) - Current of Trauma Center : Still Much to be Improved
Proposal for Improvement of the System for
Dedicated Trauma Specialis
Hyun-min Cho (Pusan National Univ. Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Symposium 10 (KR) - Current of Trauma Center : Still Much to be Improved
Jong-Min Park (National Trauma System Management Office)
1992-1998 M.D., Chungnam National University College of Medicine, Daejon, Korea
2006-2008 M.S., Graduate school, Ajou University School of Medicine, Suwon, Korea
1998-2003 Intern & Resident, Department of Surgery, Ajou University Hospital,
Suwon, Korea
2003-2006 Public health doctor, Jeju, Korea
2006-2007 Fellow in Upper gastrointestinal division, Department of Surgery, Ajou
University Hospital, Suwon, Korea
2003- Member, Korean Surgical Society
2006- Member, Korean Gastric Cancer Association
2007- Member, Korean Society of Endoscopic & Laparoscopic Surgeons
2007- Member, Korean Society of Clinical Oncology
2012- Member, Korean Society of Traumatology
Education
Postdoctoral
Training
Societies
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Symposium 10 (KR) - Current of Trauma Center : Still Much to be Improved
Outcomes of the Supporting Services for
Installation of Regional Level 1 Trauma
Centers
Jong-Min Park (National Trauma System Management Office)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
In Korea, injury is the third most common cause of death after cancer and cerebrovascular dis-
ease but is the major cause of death for working age population under age of 40 years old. Also,
the preventable trauma death rate is still higher than developed country. This result increased the
awareness of the need for establishing the trauma system. For this reason, the supporting services
for installation of regional level 1 trauma centers was started in 2012 by the Ministry of Health and
Welfare. The purpose of this service is to designate 17 regional level 1 trauma centers evenly across
the country and to provide adequate care for seriously injured patients 24 hours a day, 7 days a
week. As a result, the preventable trauma death rate will be lower to level of developed countries
by 2020. As of November 2016, 16 regional level 1 trauma centers were selected and 9 of them
were officially opened. If the project is completed as planned, quality of all phases of trauma care
(prehospital, transport, and hospital) is high, and lives of seriously injured patients can be saved
and disabilities can be minimized.
Key Words: Wounds and injuries, trauma, death, hospitals, transportation
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서론
국내에서 운수사고, 추락, 익사, 화상, 중독, 자살, 타살 등 손상으로 인한 사망은 전체 사망 원인
중 암, 뇌혈관질환에 이어 3위를 차지하고 있으며[1], 국내외적으로 40세 이하의 생산 가능 활동인구
에서 주요한 사망원인으로 높은 사망률뿐만 아니라 심각한 후유 장애로 인한 일상 복귀의 지연으로
막대한 사회 경제적 비용 손실을 초래하는 질환으로 인식되고 있다. 2012년 우리나라에서 질병으로
인한 장재 손실 연수 중 추락은 7위, 교통 사고는 9위, 자살은 10위에 해당한다[2,3].
지역 사회 또는 한 국가의 외상 의료의 질 평가를 위해 사용되는 대표적인 지표로 외상 환자의 예
방가능사망률이 있다. 적절한 치료가 이루어졌다면 예방할 수 있었을 사망의 비율을 구하는 것으로
부적절한 치료가 환자의 사망에 직간접적으로 영향을 끼쳤을 때 예방 가능하다고 판정하는 것을 원
칙으로 하며[4-6], 적절한 외상진료체계를 갖추고 적시에 적절한 치료를 제공 받았을 때 예방 가능한
외상 사망률 또한 미국, 영국, 독일, 일본 등 선진국의 10-20%에 비하여 2배 이상 높은 수치를 보여주
고 있어 시급히 개선이 필요한 질환이다[7-16].
이에 우리나라에서는 3대 중증 응급질환으로 대표되는 급성 뇌혈관 질환, 급성 심혈관 질환, 중증
외상에 대한 응급진료가 발생 지역 내에서 24시간 상시 해당 질환에 대한 치료가 적시에 최종 제공
되도록 질환에 따른 응급의료 전달체계를 구축하고 응급환자의 사망과 후유 장애를 줄이고자 2008
년부터 중증응급질환 특성화 사업을 시작하였다. 전국에 응급의료 기관 중 평가를 통하여 중증외상
특성화 센터로 지정된 기관의 경우 전문의 당직비, 보조인력 (응급구조사, 코디네이터, 정보입력 담
당자 등) 인건비, 운영비 등의 금전적 지원이 일부 이루어졌다. 그러나, 외상 전담 전문의 및 전담 인
력은 극소수에 불과하였고 전담 인력 및 전용 시설을 갖추더라도 진료수익 대비 대기비용이 과다하
여 기관의 자발적인 투자 유인이 없었고, 의료인에게도 위험부담과 높은 근무 강도로 인해 인력 유인
및 양성에 한계가 노출되었다.
특히, 3대 중증 응급질환 중에서 중증외상은 전용 소생실, 수술실, 중환자실, 혈관조영실 등 고도
의 독립적인 전용시설이 필요하며, 다발성 손상이 빈번하여 여러 전문 진료 과목(외과, 흉부외과, 신
경외과, 정형외과, 응급의학과 등)의 즉각적인 협진이 가능한 진료체계가 필요하여 전문 의료진들에
대한 높은 대기비용으로 병원의 자발적인 투자와 참여 유도를 위한 국가의 정책적 지원이 절대적으
로 필요한 상황이었다.
본문
권역외상센터 설치지원 사업의 배경 및 목적
2011년 1월 삼호 주얼리호 석해균 선장 사건으로 인해 중증외상센터의 필요성이 시급히 대두되
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었으며 2012년 권역외상센터 설치 지원 사업을 시행하는 계기가 되었다. 권역외상센터 설치 지원 사
업은 응급의료에 관한 법률 제 30조의 2[17]를 근거로 하고 있으며, 365일 24시간 중증외상환자에게
병원도착 즉시 응급수술 등 최적의 치료를 제공할 수 있는 시설, 장비, 인력을 갖춘 외상전용 치료기
관인 권역외상센터를 설치하는 것으로 전국 어디서나 1시간 이내에 중증외상환자의 진료가 가능하
도록 권역외상센터를 균형배치 하는 것이다. 이를 중심으로 지역 내 외상환자 진료 및 신속이송체계
구축, 전문 인력 양성 등 지역사회 중증외상 관리체계의 중추기관으로서의 역할 수행을 통해 우리나
라의 예방 가능한 외상 사망률을 전국 17개 권역외상센터 선정 및 개소완료가 예상되는 2020년까지
선진국 수준인 20% 미만으로 낮추는 것을 목표로 하고 있다(2016년 권역외상센터 설치지원 사업 안
내, 보건복지부).
권역외상센터 설치지원 사업의 개요
1차적으로 2017년까지 지리적 접근성과 인구수를 고려하여 전국 5개 대권역에 17개 권역외상센
터를 균형 배치하는 것을 목표로 하고 있으며, 2016년 11월 현재까지 별도 선정된 서울의 국립중앙
의료원을 포함하여 전국에 16개 기관이 선정되었고, 시설, 장비, 인력 등에 대한 2년여의 준비 과정
을 거쳐 9개 기관이 공식 지정 받아 개소를 하였다.(Table 1).
응급의료에 관한 법률 시행규칙 제 17조의 2, 별표 7의 2 권역외상센터의 요건과 지정기준[18]에
따라 법정 지정 필수 요건으로 2개의 외상 소생실, 2개의 수술실, 20개의 중환자실, 40개의 외상병실,
1개의 혈관 조영실 및 각 실에 따른 필수 장비와 인력을 외상 전용, 전담으로 운영하도록 하고 있다.
권역외상센터는 전문의 중심으로 운영하도록 하고 있으며 외상 팀에 외과, 흉부외과, 신경외과, 정형
외과 전담 전문의를 반드시 배치하도록 하고 있다. 이에, 개소당 시설, 장비 비용으로 80억원, 운영비
로 매년 연차 별 인력 충원에 따라 전담 전문의 1인당 연간 1억 2천만원 이내, 2명 이내의 외상코디네
이터 인건비, 3억 6천만원 이내에서 비 전담 전문의의 당직비 지원 및 운영비의 10% 이내에서 외상
전담인력에 대한 교육, 훈련비 등을 국비로 지원토록 하고 있다. 국비지원 항목 외에 법정 지정요건
확보는 자부담 원칙으로 하고 있으며 국비 전담 전문의 5인당 1명의 자비 전담전문의를 총원 하도록
하고 있고, 운영비 일부는 2016년부터 인력 충원과 운영실적 등을 평가하여 지원규모를 차등하여 지
원하고 있다.
권역외상센터 현황
2016년 11월 현재 전국에 16개 권역외상센터가 선정 되었고, 이중 9개 기관이 공식 지정을 받아
개소를 하였다. 나머지 기관들도 개소를 위한 준비에 박차를 가하고 있으며, 개소한 권역외상센터들
의 경우 법적 기준에 필요한 시설과 장비들은 대부분 보유하고 있으며, 개소한 기관들의 병상 현황은
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Table 2 에 있다.
별도 선정된 국립중앙의료원을 제외하고, 부산대병원의 경우 시설, 장비비로 339억여원이 지원
되었으며, 나머지 기관들은 80억원씩 지원되었다. 운영비는 각 권역외상센터마다 매년 인력 충원을
감안하여 지급되고 있으며, 2015년 기준 15개 권역외상센터에 190여억원이 지원되었고 개소 기관이
늘고 인력 충원이 확대되면서 운영비 지원 규모는 매년 큰 폭으로 증가하고 있다(Table 3).
각 권역외상센터 별로 차이는 있으나 일부 기관과, 일부 특정 전문 과목의 전담 전문의 충원은 사
업 안내서 상의 연차 별 전담 전문의 충원 권고에 미치지 못하고 있어, 권역외상센터 본연의 업무를
충실히 이행하기 위해서는 이에 대한 대책이 필요한 상황이다(Table 4). 또한, 국립중앙의료원 중앙
응급의료센터는 2012년에 권역외상센터 외상등록체계를 개발하여 기 선정된 권역외상센터와 서울
지역 외상 공백을 해소하고 양질의 외상 전문의 양성을 위해 선정된 외상 전담 전문의 수련기관인
고대구로병원과 신촌세브란스 병원에서 전송되는 외상환자의 진료 관련 정보를 실시간으로 수집하
여 외상진료체계의 기반을 마련하고, 외상 진료의 질 향상을 위한 평가 자료 및 외상관련 연구와 정
책수립의 기초 자료를 제공하기 위해 순차적으로 구축을 하여 운영하고 있다(Table 5).
권역외상센터 설치지원 사업 시행의 결과
2012년 권역외상센터의 외상등록체계가 개발되고 2013년부터 순차적으로 외상등록체계가 구축
되면서 데이터의 안정화 단계를 거치고 2014년부터 기 구축된 권역외상센터의 외상 진료 정보가 수
집되면서 2014년과 2015년의 외상 환자 등록 현황을 비교하였다(Table 6). 2014년에 비해 2015년의
ISS 15점 초과의 중증 외상환자수와 전체 외상환자수가 증가하는 양상을 보이나, 2014년 이후 정식
개소하는 기관이 늘어나고 외상등록체계 기관이 2개 추가된 것을 고려하면 권역외상센터로의 외상
환자 집중이 충분히 이루어졌다고는 볼 수는 없을 것이다. 하지만 2015년 MERS로 인한 전체 외상 환
자 감소의 영향을 고려해야 할 것이다.
2015년 이후 매년 권역외상센터에 대한 평가가 진행 중으로 최근의 자료는 공개가 어려워 2014
년 외상등록체계가 구축된 별도 선정 기관인 국립중앙의료원, 10개의 권역외상센터, 2개의 외상 전
담 전문의 수련기관의 외상 환자 등록 자료를 분석해 보면 다음과 같다. 2014년 외상등록체계에 등
록된 전체 외상환자수는 22,172명으로 중증도 점수 ISS(Injury Severity Score) 1-8점이 12,073명으
로 54.5%, 9-15점이 5,671명으로 25.6%, 15점 초과가 4,192명으로 18.9%였다. 남성이 여성에 비하
여 1.91배가 많았으며, 연령대는 50대가 19.1%로 제일 많았으나 20대에서 70대까지 고르게 분포하
였다. 손상 유형은 둔상 90.1%, 관통상 6.1%, 화상 1.1%, 사고 종류는 미끄러짐이 25%, 교통사고
21.3%, 추락 15.3% 순이었다 내원 경로는 직접내원이 60.7%, 전원이 38.4%, 내원 수단은 119 구급차
38%, 자동차 35.1%, 기타 구급차 24.1% 순이었다. 각종 지표에 대한 빈도는 Table 7. 에 있다. 2015
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년에는 2014년에 선정된 의정부성모병원과 안동병원의 자료가 추가되어 등록된 전체 외상환자수
는 31032명이며 중증도, 성비, 연령대, 손상 유형, 내원 경로, 내원 수단과 각종 지표 값의 구성비는
2014년에 비하여 유의한 변동은 없었다.
결론
2012년 권역외상센터 설치 지원 사업이 시행된 이후 2016년 11월 현재까지 권역외상센터로 선정
된 16개 기관 중 정상적인 본연의 업무를 수행할 수 있는 정식 개소한 권역외상센터는 9개에 불과하
며, 이마저도 대부분 2014년 이후에 개소를 하여 아직 사업 시행 초기에 해당된다고 할 수 있다. 개
소 기관들이 늘면서 중증외상 환자들은 최종 치료 기관인 권역외상센터로의 빠른 이송과 집중이 필
요하다는 것에 동의하고 있으나 현장에서 적절한 병원으로의 이송을 위한 환자 분류 체계, 이송 인
력에 대한 체계적인 교육뿐만 아니라 책임소재에 대한 법적, 제도적 정비는 미진한 상태이며, 개소를
준비하는 여러 기관들에서 사업 시행의 지연이 나타나고 있다. 이러한 이유 중 대표적인 예로 경제
적인 논리만을 내세워 사업 초기의 초심을 잃은 병원 경영진들의 철학의 부재, 전용 시설 확보를 위
한 공사의 지연과 위에서 언급한 전담 인력 채용의 어려움이다. 심지어 정식 지정을 받아 개소한 권
역외상센터들의 경우에도 일부 전문 과목의 경우 수급 불균형으로 필수 전담 전문의 채용에 어려움
을 호소하는 기관이 많은 실정이지만 높은 업무 강도에 비하여 충분한 대우를 받지 못해 이직을 하
거나 외상 진료를 포기하는 경우도 자주 접하게 된다.
정부는 권역외상센터의 안정적인 조기 안착을 위해 충분한 외상 전담 인력의 양성과 전담 인력에
대한 적극적인 처우 개선을 위해 노력해야 하며, 수가 합리화와 같은 지원을 통해 권역외상센터가 진
료만으로도 재정 자립을 할 수 있도록 경영 수지 개선을 위한 법적, 제도적 개선이 필요하다.
선정된 권역외상센터는 사명을 갖고 빠른 개소를 위해 노력해야 하며, 개소한 기관들의 경우 지
역 외상체계의 리더십을 갖고 양적 확장뿐 만 아니라 질적 향상을 위한 다음과 같은 활동에 적극 노
력하여 초기의 구축, 성장 단계를 벗어나 중장기의 안정화, 성숙 단계의 권역외상센터가 이루어질 것
이다.
● 병원 전 단계: 적절한 이송체계 확립을 위한 법적, 제도적 정비 및 부처간 협의, 병원 전 이송
인력에 대한 적절한 현장 분류 체계 확립, 이송 시 소생 및 활력 징후 유지를 위한 이송 인력
의 교육, 현장 이송 인력과의 의사 소통 강화 방안 등
● 병원 단계: 최종 치료 제공 기관으로서의 역할 강화 및 기능 정립, 충분한 전담 인력의 확보 및
양성, 표준 진료 지침의 확립, 진료 시 발생 가능한 오류의 최소화, 전담 전문의 외에 기관 내
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전문 인력과의 포괄적 협력 방안 강구, 배제적 외상센터가 아니라 포괄적 협력 시스템을 갖춘
외상센터의 확립 등
● 지역 사회 외상체계의 확립: 특수 외상 분야(중증 화상, 소아외상, 미세수술 등)의 인력 확보
또는 지역 내 질환별 네트워크 강화 방안, 지역 외상체계에서 리더십을 같고 중증 외상환자
진료에 있어서 지역 응급의료기관과의 역할 조정 및 적절한 병원간 이송에 대한 협력 방안 논
의 등
ACKNOWLEDGMENTS
데이터 수집과 분석을 위해 도움을 주신 국립중앙의료원 중앙응급의료센터 외상사업관리단 이진
석 부단장, 김소라 연구원, 나선경 연구원, 이윤희 연구원, 임보라미 연구원, 채하나 연구원에게 감사
드립니다.
REFERENCES
1. Korean Statistical Information Service. Cause of Death Statistics. Daejeon: Statistics Korea;
2010[cited 2011 Sep 11], Available from http://kosis.kr/news/news_02List.jsp?q_search_
key=all_data&q_search_text=%EC%82%AC%EB%A7%9D%EC%9B%90%EC%9D%B8&LS_btn.
x=0&LS_btn.y=0.
2. Murray CJ, Lopez AD, Jamison DT. The global burden of disease in 1990: summary results,
sensitivity analysis and future directions. Bull World Health Organ. 1994; 72(3): 495-509.
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Park H, Yoon SJ. Disability-adjusted Life Years for 313 Diseases and Injuries: the 2012 Korean
Burden of Disease Study. J Korean Med Sci. 2016; Suppl2: S146-S157.
4. Chiara O1, Cimbanassi S, Pitidis A, Vesconi S. Preventable trauma deaths: from panel review
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5. Esposito TJ, Sanddal TL, Reynolds SA, Sanddal ND. Effect of a voluntary trauma system on
preventable death and inappropriate care in a rural state. J Trauma. 2003; 54(4): 663-669; dis-
cussion 669-670.
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6. Oliver GJ, Walter DP. A Call for Consensus on Methodology and Terminology to Improve
Comparability in the Study of Preventable Prehospital Trauma Deaths: A Systematic Literature
Review. Acad Emerg Med. 2016; 23(4): 503-510.
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ma system: The medical audit committee: Composition, cost and results. J Trauma 1987; 27:
866-875.
8. Draaisma JM, de Hann AF, Goris RJ: Preventable trauma deaths in the Netherlands: A pro-
spective multicenter study. J Trauma 1989; 29: 1552-1557.
9. Saltzherr TP, Wendt KW, Nieboer P, Nijsten MW, Valk JP, Luitse JS, Ponsen KJ, Goslings JC.
Preventability of trauma deaths in a Dutch Level-1 trauma centre. Injury. 2011; 42(9): 870-3.
10. .Esposito TJ, Sanddal ND, Hansen JD, Reynolds S. Analysis of preventable trauma deaths
and inappropriate trauma care in a rural state. J Trauma. 1995 Nov; 39(5): 955-962.
11. Sanddal TL, Esposito TJ, Whitney JR, Hartford D, Taillac PP, Mann NC, Sanddal ND. Anal-
ysis of preventable trauma deaths and opportunities for trauma care improvement in utah. J
Trauma. 2011; 70(4): 970-977.
12. Schoeneberg C, Schilling M, Probst T, Lendemans S. Preventable and potentially prevent-
able deaths in severely injured elderly patients: a single-center retrospective data analysis of a
German trauma center. World J Surg. 2014; 38(12): 3125-32.
13. Motomura T, Mashiko K, Matsumoto H, Motomura A, Iwase H, Oda S, Shimamura F,
Shoko T, Kitamura N, Sakaida K, Fukumoto Y, Kasuya M, Koyama T, Yokota H. Preventable
trauma deaths after traffic accidents in Chiba Prefecture, Japan, 2011: problems and solutions.
J Nippon Med Sch. 2014; 81(5): 320-327.
14. Koo Young Jung, Jun Sig Kim, Yoon Kim. Problems in Trauma Care and Preventable
Deaths. J Korean Soc Emerg Med. 2001; 12(1): 45-56.
15. Yoon Kim, Koo Young Jung, Kwang Hyun Cho, Hyun Kim, Hee Cheol Ahn, Se Hyun Oh,
Jae Baek Lee, Su Jin Yu, Dong Ik Lee, Tai Ho Im, Sung Eun Kim, Jae Hyun Park. Preventable
Trauma Deaths Rates and Management Errors in Emergency Medical System in Korea. J Kore-
an Soc Emerg Med. 2006; 17(5): 385-394.
16. Hyun Kim, Koo Young Jung, Sun Pyo Kim, Sun Hyu Kim, Hyun Noh, Hye Young Jang,
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Han Deok Yoon, Yun Jung Heo, Hyun Ho Ryu, Tae oh Jeong, Yong Hwang, Jung Min Ju,
Myeong Don Joo, Sang Kyoon Han, Kwang Won Cho, Ki Hoon Choi, Joon Min Park, Hyun
Min Jung, Soo Bock Lee, Yeon Young Kyong, Ji Yeong Ryu, Woo Chan Jeon, Ji Yun Ahn,
Jang Young Lee, Ho Jin Ji, Tae Hun Lee, Oh Hyun Kim, Youg Sung Cha, Kyung Chul Cha,
Kang Hyun Lee, Sung Oh Hwang. Changes in Preventable Death Rates and Traumatic Care
Systems in Korea. J Korean Soc Emerg Med. 2012; 23(2): 189-197.
17. National Law Information Center, Emergency Medical Service Act, Article 30-2(Des-
ignation of Regional Trauma Center). Sejong, Korea Ministry of Government Legislation,
Available from http://www.law.go.kr/lsSc.do?menuId=0&p1=&subMenu=1&nwYn=1&sec-
tion=&tabNo=&query=%EC%9D%91%EA%B8%89%EC%9D%98%EB%A3%8C%EC%97%90%20
%EA%B4%80%ED%95%9C%20%EB%B2%95%EB%A5%A0#undefined.
18. National Law Information Center, Emergency Medical Service Act, Ordinance of the
Ministry of Health and Welfare, Article 17-2(Designation Criteria and Requirements of Re-
gional Trauma Center). Sejong, Korea Ministry of Government Legislation, Available from
http://www.law.go.kr/lsSc.do?menuId=0&p1=&subMenu=1&nwYn=1§ion=&tab-
No=&query=%EC%9D%91%EA%B8%89%EC%9D%98%EB%A3%8C%EC%97%90%20
%EA%B4%80%ED%95%9C%20%EB%B2%95%EB%A5%A0%20%EC%8B%9C%ED%96%89%EA
%B7%9C%EC%B9%99#undefined.
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Table 1. Current state of the supporting services for installation of regional trauma centers.
Large region Special selection(2)
Selected regional trauma center(14)
*Official opening, Designated regional trauma center(9)
Additional selection(1)
ICapital area
Kangwon
National Medical Cen-ter(Seoul)
*Gachon University Gil Medical Cen-ter(2012, Incheon)
*Wonju Severance Christian Hosp.(2012, Gangwon)
*Ajou University Hosp.(2013, South Gyeonggi)
Uijeongbu St. Mary’s Hosp.(2014, North Gyeonggi)
II Chungcheong
*Dankook University Hosp.(2012, Chun-gnam)
*Eulji University Hosp.(2013, Daejeon)
Chungbuk National University Hosp.(2015, Chungbuk)
IIIJeolla
Jeju
*Mokpo Hankook Hosp.(2012, Jeon-nam)
*Chonnam National University Hosp.(2013, Gwangju)
Wonkwang University Hosp.(2015, Jeon-buk)
Cheju Halla General Hosp.(2016, Jeju)
IV Gyeongbuk
Kyungpook National Hosp.(2012, Dae-gu)
Andong Hosp.(2014, Gyeongbuk)
V Gyeongnam *Pusan National Uni-versity Hosp.(Busan) *Ulsan University Hosp.(2013, Ulsan) Gyeongnam
*9 out of 15 selected hospitals were officially opened and designated as regional trauma center.
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Table 2. Current situation of hospitals facilities(bed number) in 9 designated regional trauma cen-
ters as of June 2016.
Region Selec-tion Year
Designa-tion Date
Hosp. Name Space Scale(beds)
Oper-ation Room
ER
Resus-citation Room
ER obser-vation area
ICU Ward Total
Incheon `12.11 `14.07.21 Gachon University Gil Medical Center
2 2 6 20 52 80
Chungnam `12.11 `14.11.13 Dankook Uni-versity Hosp.
2 2 6 20 40 68
Jeonnam `12.11 `14.02.21 Mokpo Han-kook Hosp.
2 2 6 20 40 68
Gangwon `12.11 `15.02.12 Wonju Sever-ance Christian Hosp.
2 2 6 20 52 80
Busan `08.03 `15.11.09 Pusan Nation-al University Hosp.
6 2 12 50 80 144
South Gyeo-nggi
`13.07 `16.06.13 Ajou Universi-ty Hosp.
3 2 6 40 60 111
Ulsan `13.07 `15`09`17 Ulsan Univer-sity Hosp.
2 2 6 20 40 68
Daejeon `13.07 `15.11.24 Eulji Universi-ty Hosp.
2 2 9 20 40 71
Gwangju `13.07 `15.09.22 Chonnam National Uni-versity Hosp.
2 2 6 20 41 69
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Table 3. Current state of supporting for the operating expense in regional trauma centers.
Selection Year
Designa-tion Date
Hosp. Name Support for the operating Expense
(1 million won)
‘12 ‘13 ‘14 ‘15
Special selection
- National Medical Center 574 454 480 540
‘12 ‘14.7.21 Gachon University Gil Medi-cal Center
86 1,440 1,920 1,753
-- Kyungpook National Hosp. 38 1,440 1,920 1,590
‘’14.11.13 Dankook University Hosp. 60 1,440 1,920 1,620
‘14.2.21 Mokpo Hankook Hosp. 146 1,440 1,920 2,040
‘15.2.12 Wonju Severance Christian Hosp.
150 1,440 1,920 1,740
‘13 ‘15.11.9 Pusan National University Hosp.
364 720 1,440 1,900
‘16.6.13 Ajou University Hosp. 60 1,440 1,490
‘15.9.17 Ulsan University Hosp. 86 1,440 1,470
‘15.11.24 Eulji University Hosp. 529 1,440 1,350
‘15.9.22. Chonnam National University Hosp.
300 1,440 1,440
‘14 - Andong Hosp. 60 780
- Uijeongbu St. Mary’s Hosp. 60 1,200
‘15 Chungbuk National Universi-ty Hosp.
180
Wonkwang University Hosp. 60
‘16.11 - Cheju Halla General Hosp.
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Table 4. Human resource(specialty) status in regional trauma centers as of June 2016.
Selec-tion Year
Designa-tion Date
Hosp. Name Dedicated Specialty Supporting Specialty Total
GS CS OS NS ANES RAD EM
Special selec-tion
- National Medical Center
2 0 1 1 0 1 1 6
‘12 ‘14.7.21 Gachon Univer-sity Gil Medical Center
9 4 1 2 1 1 1 19
-- Kyungpook Na-tional Hosp.
1 1 4 0 1 0 0 7
‘’14.11.13 Dankook Univer-sity Hosp.
6 1 1 2 2 3 0 15
‘14.2.21 Mokpo Hankook Hosp.
3 4 3 5 1 2 4 22
‘15.2.12 Wonju Severance Christian Hosp.
5 2 3 2 2 0 1 15
‘13 ‘15.11.9 Pusan National University Hosp.
8 6 4 3 2 1 0 24
‘16.6.13 Ajou University Hosp.
6 1 3 1 2 1 1 15
‘15.9.17 Ulsan University Hosp.
7 1 3 1 1 2 0 16
‘15.11.24 Eulji University Hosp.
1 0 3 0 1 1 1 7
‘15.9.22. Chonnam Na-tional University Hosp.
4 2 4 2 2 1 1 16
‘14 - Andong Hosp. 5 2 1 0 0 1 1 10
- Uijeongbu St. Mary’s Hosp.
4 1 2 1 1 0 1 10
‘15 Chungbuk Na-tional University Hosp.
3 0 1 2 1 2 0 9
Wonkwang Uni-versity Hosp.
3 1 2 3 1 0 0 10
‘16.11 - Cheju Halla Gen-eral Hosp.
3 0 0 0 0 0 0 3
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Table 5. The operating status of the trauma registry in regional trauma centers and trauma training
centers.
Selection Year
Designa-tion Date
Hosp. Name Develop-ment of trauma registry
Operating status of trauma registry
‘12 ‘13 ‘14 ‘15 ‘16
Special selection
- National Medical Center - O O O O
Trauma training center
‘14 Korea University Guro Hosp. - - O O O
‘14 Yonsei University Severance Hosp. - - O O O
‘12 ‘14.7.21 Gachon University Gil Medical Center
- O O O O
-- Kyungpook National Hosp. - O O O O
‘’14.11.13 Dankook University Hosp. - O O O O
‘14.2.21 Mokpo Hankook Hosp. - O O O O
‘15.2.12 Wonju Severance Christian Hosp. - O O O O
‘13 ‘15.11.9 Pusan National University Hosp. - - O O O
‘16.6.13 Ajou University Hosp. - - O O O
‘15.9.17 Ulsan University Hosp. - - O O O
‘15.11.24 Eulji University Hosp. - - O O O
‘15.9.22. Chonnam National University Hosp.
- - O O O
‘14 - Andong Hosp. - - - O O
- Uijeongbu St. Mary’s Hosp. - - - O O
‘15 - Chungbuk National University Hosp.
- - - - O
- Wonkwang University Hosp. - - - - O
‘16.11 - Cheju Halla General Hosp. - - - - -
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Table 6. Comparison of the registered number of patients in regional trauma centers between 2014
and 2015.
Selection Year
Desig-nation Date
Hosp. Name 2014 2015
ISS<15 ISS>15 Total ISS<15 ISS>15 Total
Special selection
- National Medical Center
46 13 59 394 24 418
‘12 ‘14.7.21 Gachon University Gil Medical Center
2588 509 3097 2656 499 3155
-- Kyungpook Na-tional Hosp.
1268 438 1701 1138 364 1502
‘’14.11.13 Dankook Universi-ty Hosp.
1985 353 2338 1702 402 2104
‘14.2.21 Mokpo Hankook Hosp.
1879 299 2178 1986 312 2298
‘15.2.12 Wonju Severance Christian Hosp.
2185 345 2530 2593 484 3077
‘13 ‘15.11.9 Pusan National University Hosp.
1340 454 1794 1851 481 2332
‘16.6.13 Ajou University Hosp.
1725 540 2265 1626 483 2109
‘15.9.17 Ulsan University Hosp.
1002 281 1283 1304 388 1692
‘15.11.24 Eulji University Hosp.
1873 419 2292 1242 330 1572
‘15.9.22. Chonnam Nation-al University Hosp.
1305 450 1755 1371 491 1862
‘14 - Andong Hosp. - - 2556 300 2856
- Uijeongbu St. Mary’s Hosp.
- - 2108 387 2495
Mean
(±SD)
- 1563.3
(±682.4)
382.8
(±144.9)
1935.6
(±788.2)
1732.8
(±658.5)
380.4
(±128.8)
2113.2
(±740.2)
Total
(%)
17196
(80.7)
4101
(19.3)
21292
(100)
22527
(82)
4945
(18)
27472
(100)
Data extraction date: Jan 29, 2015 from regional trauma center trauma registryThere may be some fluctuation, according to the data extraction date.
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Table 7. Each index for registered patients in regional trauma centers in 2014.
Index N(Valid number) Mean Median Standard Deviation
Scene-to-hosp. time(min) 6839 62.3 25.0 1639.4
Injury-to-hosp. time(min) 22081 1305.0 105.0 14621.9
Massive transfusion time(min) 243 51.6 41.0 36.5
ER stay time(min)
ISS 0-8
9-15
>15
22170(100)
11853(53.5)
5575(25.1)
4127(18.6)
361.5
346.1
456.2
283.1
237.0
247.0
272.0
176.0
559.3
346.1
888.4
369.0
ICU stay time(day) 4701 8.4 4.0 15.6
Result of leaving ER(%)
Admission
Transfer
Death
22172(100)
19610(88.4)
2207(10.0)
351(1.6)
Result after admission(%)
Normal discharge
Transfer
Death
19136(100)
15603(81.5)
2649(13.8)
608(3.1)
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Jung Joo Hwang (Eulji Univ. Hospital)
Moderator
Seok Ho Choi (Dankook Univ. Hospital)
Jung Joo Hwang (Eulji Univ. Hospital)
1F. Seminar 1
Symposium 6 (KR)
Medical Treatment Guideline Committee
06-24 (Sat.), 2017
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Symposium 6 (KR) - Medical Treatment Guideline Committee
Soon Chang Park (Pusan National Univ. Hospital)
2013.05 - Present: Pusan National Univ. Hospital (Assistant Professor)
2010.04 - 2013. 04: Daejeon Armed Force Military School of Medicine ( Instructor)
2006.03 - 2010.02: Pusan National Univ. Hospital (Residence)
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Symposium 6 (KR) - Medical Treatment Guideline Committee
CPR in Blunt Trauma Patients: Indication and
Contraindication, How Long?
Soon Chang Park (Pusan National Univ. Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Symposium 6 (KR) - Medical Treatment Guideline Committee
Junsik Kwon (Ajou Univ. Hospital)
Graduated from Yonsei Univ. School of Medicine
Residence at Seoul National Univ. Hospital
Former Aju Univ. Hospital Assistant Professor
2011 - 2013 Aju Univ. Hospital (Instructor)
2016 - Aju Univ. Hospital (Assistant Professor)
Education
Career
221
Symposium 6 (KR) - Medical Treatment Guideline Committee
Vascular Access in Shock Patients
Junsik Kwon (Ajou Univ. Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
외상환자 처치의 질을 보다 높이기 위한 논의가 계속되고 있지만, 아직까지도 외상 분야에서 가장
큰 이슈는 예방 가능한 외상 사망률을 줄이는 것이다. 외상으로 인한 초기 사망 중 예방 가능한 원인
중 대부분은 출혈에 대한 대처를 실패했기 때문인데, 이를 막기 위해 출혈 부위에 대한 신속하고 적
절한 지혈이 가장 강조되는 것이 사실이지만, 동시에 선제적이고 균형 있는 Resuscitation의 시행 역
시 중요하다. 이를 위해 출혈이 예상 되는 모든 외상 환자에게 Resuscitation을 위한 신뢰도가 높은
복수의 큰 구경의 IV line을 확보하는 것이 필수적이다. ATLS에서는 이러한 환자들에게 양 상지에 큰
구경의 말초 IV line을 확보하는 것을 고려하도록 하며, 많은 연구에서 출혈양이 15 - 20%를 넘지 않
는 환자의 경우 내경의 size가 최소 2mm가 넘는 catheter를 두 개 이상 확보한 다면 충분하다는 보고
를 하고 있다. 현재 한국에는 여러가지 말초 및 중심 정맥용 catheter가 제품이 들어와 있으며, 그 구
경과 길이에 따라 목적이 다른데, 응급실 및 Trauma bay에서 환자를 처치하는 의사 및 간호사들이
이미 병원에 들어와 있는 catheter의 종류와 사용법에 익숙해지는 데에는 많은 노력이 필요하다. 특
히 쇼크에 빠진 중증 외상환자는 collapse된 혈관으로 인해 catheter 삽입에는 매우 숙련된 기술 및
정확한 decision making이 필요하다. 이런 상황을 마주하였을 때 실패하지 않기 위해 염두 해 두어
야 하는 몇 가지 원칙은 다음과 같다.
1. Make sure you are familiar with the techniques for vascular access before the trauma case
arrives
2. Use the technique for vascular access in which you are most experienced
3. Do not hesitate to start simultaneous exposure of several different veins
4. Do not forget the cubital fossa as a possible site for vein exposure
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원칙을 세워 대처 하였으나 항상 성공적인 것은 아니며, 만약 일반적인 방법으로는 실패가 예상
되는 상황이라면 다음 세 가지 대응책을 고려해 보는 것이 도움이 될 수도 있다.
1. Surgical exposure of veins in the cubital fossa or on the leg
2. Percutaneous catheterization of the femoral vein
3. Central venous catheterization in the subclavian vein or external and internal jugular vein
Vascular access의 일반 원칙을 준수하고, 어려운 Case에 대처할 수 있는 몇 가지 대안을 나름대로
준비하여, 이에 대한 기술적인 숙련도를 갖추기 위해 노력한다면 최소한 초기에 어의 없는 이유로 환
자를 잃는 경험은 줄일 수 있을 것이다.
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The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Symposium 6 (KR) - Medical Treatment Guideline Committee
Do Wan Kim (Chonnam National Univ. Hospital)
Feb. 2005 Bachelor’s Degree, Chonnam National University College of Medicine, GJ, Korea
Feb. 2013 Chonnam National University College of Medicine, GJ, Korea
Mar. 2015 ~ Feb. 2017 Master’s Degree, A candidate for the Doctor’s Degree,
Chonnam National University College of Medicine, GJ, Korea
2015 Lee YK Academy Award of Korean Society for Thoracic and Cardiovascular
Surgery
2012 Korean Board of Thoracic and Cardiovascular Surgery
2015 Korean Board of Critical Care Medicine
2017 Korean Board of Trauma Surgery
Education
Academic Honors
Medical Licensure
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Symposium 6 (KR) - Medical Treatment Guideline Committee
Crystalloid Versus Colloid:
What is the Best Treatment for Shock
Patients?
Do Wan Kim (Chonnam National Univ. Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
Multiple injury continues to represent a global public health issue and mortality and morbidity
in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on
the management of trauma patients [1]. The administration of intravenous fluids for treatment is the
most common intervention
in acute phase state. There is increasing evidence that the type of fluid may directly affect pa-
tient centred outcomes. There is a lack of evidence that colloids confer clinical benefit over crystal-
loids and they may be associated with harm. Hydroxyethyl starch preparations are associated with
increased mortality and use of renal replacement therapy in critically ill patients, particularly those
with sepsis; albumin is associated with increased mortality in patients with severe traumatic brain
injury [2].
Classic concept of the traumatic hypovolemic state, intravenous large amounts of normal saline
injection. And massive bleeding can cause even greater impacts on homestatic function, because
the changes of coagulation factors occur earlier than those of PLT in functional disorders because
of surgical bleeding [3].
Goals and endpoints for resuscitation and a review of initial fluid choice are discussed, along
with the coagulopathy of trauma and its management, how to address hemorrhagic shock, and
new pharmacologic treatment for hemorrhagic shock. For many years, the gold standard of treat-
ment was the rapid restoration of circulating volume with crystalloid solutions to normal, or even
supraphysiologic levels.
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Research over the past 30 years has yielded significant improvements in the treatment of various
etiologies of shock, including the treatment of shock, using on early goal-directed Therapy. How-
ever, all types of shock are not the same, and different etiologies require different approaches. In-
travascular losses that result from third spacing. Aggressively replacing these losses with crystalloid
before irreversible damage occurs makes perfect sense. However, losses from hemorrhage include
water, electrolytes, colloids, clotting factors, platelets, and blood cells [4].
Although classic resuscitation and strategies may show effective levels or patterns during recov-
ery state and wound healing, the pathological reaction of shock can be clearly distinguished from
physiological processes [5]. Damage control resuscitation (DCR), a strategy combining the tech-
niques of permissive hypotension, haemostatic resuscitation and damage control surgery has been
widely adopted as the preferred method of resuscitation in patients with haemorrhagic shock. The
over-riding goals of DCR are to mitigate metabolic acidosis, hypothermia and coagulopathy and
stabilise the patient as early as possible in a critical care setting. Diagnosing and treating the shock
with massive trauma protocols as well as newer fluid resuscitation [6].
An important parameter for clinical outcome is to succeed in stopping the shock preferentially
within initial event. Additional end organ damage in the early phase is induced by shock itself and
aggravated by consumption and dilution of clotting factors. Although different aspects have to be
taken into consideration when viewing at bleedings induced by severe trauma compared to those
caused by major surgery, the basic mechanism is similar [7].
Finally, massive bleeding does due to massive bleeding-induced hemorrhagic shock. To evalu-
ate the role of the important mechanism of bleeding and shock, such as distributive pattern acido-
sis, and hypothermia used separately and in various combinations, in impairment of clot formation
and platelet function. On the basis of these findings, it would be possible to better understand the
underlying mechanisms shock process [8].
In conclusion, mortality in patients with trauma shock is high, and the past years has seen a
significant shift in resuscitation used to manage severely shock patients. However, the evidence to
support such change is limited. In order to move forward large randomised controlled trials and
well conducted observational studies with pragmatic endpoints are needed to improve our under-
standing of the complex interplay between bleeding and resuscitation, traumatic coagulopathy and
mortality.
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REFERENCES
1. Rossaint R. The European guideline on management of major bleeding and coagulopathy fol-
lowing trauma: fourth edition. Crit Care.2016 Apr 12; 20: 100
2. Myburgh JA. Fluid resuscitation in acute medicine: what is the current situation? J Intern Med
2015; 277: 58-68.
3. Eikelboom JW, Mehta SR, et al. Adverse impact of bleeding on prognosis in patients with
acute coronary syndromes. Circulation 2006; 114: 774-82.
4. Cherkas D. Traumatic hemorrhagic shock : advances in fluid management. Emerg Med Pract.
2011 Nov;13(11):1-19; quiz 19-20.
5. S Gando. Pathophysiology of Trauma-Induced Coagulopathy and Management of Critical
Bleeding Requiring Massive Transfusion. Semin Thromb Hemost. 2016 Mar; 42(2): 155-65.
6. Curry N. What’s new in resuscitation strategies for the patient with multiple trauma? Injury.
2012 Jul; 43(7): 1021-8.
7.A Meißner. Massive Bleeding and Massive Transfusion. Transfus Med Hemother. 2012 Apr;
39(2): 73-84
8. Yunos NM.Chloride-liberal vs. chloride-restrictive intravenous fluid administration and acute
kidney injury: an extended analysis. Intensive Care Med. 2015 Feb; 41(2): 257-64.
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Symposium 6 (KR) - Medical Treatment Guideline Committee
Maru Kim (The Catholic Univ. Hospital)
Clinical Assistant Professor, Department of Trauma Surgery, Regional Trauma Center, Uijeongbu St. Mary’s
Hospital, Catholic University of Korea
Educational Background & Professional Experience
2000.3~2006.2 Graduated from Catholic University of Korea,
2006.3~2011.2 Training at Catholic Medical Center
2013.5~2014.5 Armed Force Goyang Hospital
2014.5~2015.2 Fellowship at Uijeongbu St. Mary’s Hospital
2015.3~ Clinical assistant professor, Department of Trauma Surgery, Regional Trauma Center, Uijeongbu
St.Mary’s Hospital
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Initial Response to Trauma Team Activation:
Which Specialists Should be Involved?
Maru Kim (The Catholic Univ. Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
Treating major trauma patients is a complex process, therefore, no single physician can manage
the patient alone. Because major trauma patients are easy to have multiple injuries from brain,
chest, abdomen to extremity. To secure patients’ survivor, it requires close interactions between
multidisciplinary trauma team. In initial response, it also requires several specialists. In 2016
guideline of regional trauma center from Ministry of Health and Welfare, main trauma team is
recommended to include at least two trauma surgeons (thoracic and cardiovascular surgeon, sur-
geon), one emergency physician and one neurosurgeon. However there exist other many guide-
lines about trauma and they recommend to make initial response team variously. Putting the right
man in the right place is difficult. Too few specialists in initial response team might make improper
management in emergent situation. Too many specialists in the team might bring conflict between
the parts. Each trauma center could set initial response team according to individualized needs and
situation. With proper team member and harmonious control of trauma team leader, we can yield
better outcome of trauma patients.
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Symposium 6 (KR) - Medical Treatment Guideline Committee
Bachelor of Medicine, Kyunghee University (2004)
Master of Medicine, Gachon University of Graduate School (2008)
Doctor of Medicine, Gachon University of graduate School (2015)
Internship, Resident in Department of Surgery at Gachon University Gil Medicine
Center (2004~2009)
Army Surgeon (27th Division of Medical Corps, the Service Support Group) (2009~2012)
Trauma Surgeon at Gachon University Gil Medicine Center (2012~2013)
Clinic Assistant Professor of Trauma Surgeon at Gachon University Gil Medicine Center
(2014~2015)
Assistant Professor of Traumatology at Gachon University of Medicine (2016~ )
Medical Doctor's License (2004)
Surgery Specialist (2009)
Traumatic Surgical Specialist (2014)
Critical Care Specialist (2015)
Education
Experience
License
Giljae Lee (Gachon Univ. Gil Hospital)
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Symposium 6 (KR) - Medical Treatment Guideline Committee
Trauma Team Leader: Emergency Physician
vs. Trauma Surgeon
Giljae Lee (Gachon Univ. Gil Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
The size and composition of the trauma team may vary with hospital size, the severity of injury,
and the corresponding level of trauma team activation. The leadership and teamwork structure for
trauma care is generally dictated by provider preference, institutional history, and local culture rath-
er than uniform standards.
Coordinating doctors, nurses, and ancillary staff to care for patients requires teamwork and lead-
ership. This is particularly true in emergency settings where providers from numerous specialties
converge to care for critically ill patients with limited data and under strict time constraints.
Trauma team leaders (TTL) may be emergency physicians, general surgeons, they may also be
anesthesiologists, intensivists, or with an interest in trauma and with relevant experience and train-
ing. Primary role of TTL is to lead the resuscitative care of the major trauma patient. Subsequent
inpatient care is managed by the staff of the appropriate clinical service.
Leadership styles are divided into two main categories: directive or empowering. Directive lead-
ership is typical of a military chain of command. This type of leadership is effective when tasks are
simple, straightforward, and/or the leader is the only team member with expertise.
In empowering leadership, leaders delegate responsibility, allowing colleagues to make deci-
sions while the leader focuses on team communication and coordination. Newer theories postulate
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that empowering (shared) leadership is more effective when tasks are complex. These theories
suggest the more complex a task, the more necessary it is for team members to share the responsi-
bility of management of information, communication, and adaptability to achieve success.
Trauma resuscitation has elements that are simple/task-oriented and components that are high-
ly complex requiring team member coordination. As such, directive and empowering leadership
styles might both play a role.
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Duck Hyun Ryu (Armed Force Capital Hospital)
Moderator
Byung-Seop Choi (COL, Armed Forces Medical Command)
Beomman Ha (COL, Armed Forces Capital Hospital)
1F. Seminar 1
Symposium 9
The Future of Military Trauma Care, Patient First in Military Trauma
06-24 (Sat.), 2017
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Symposium 9 - The Future of Military Trauma Care, Patient First in Military Trauma
Jeong Kook Baek (MAJ, Armed Forces Ildong Hospital)
2000-2004 Korea Military Academy
2006-2010 Doctor of Medicine(M.D.) in Seoul National University Medical School
2010-2011 Internship at Armed Forces Capital Hospital
2011-2014 Residency(Orthopedic Surgery) in Seoul National University Hospital
2014-2016 Master’s degree in Orthoedic surgery at Seoul National University
Hospital
2015-2017 Trauma Fellow in Seoul National University Hospital
- General Trauma/Microsurgery/Reconstruction
Education
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2016 Combat Orthopedic Trauma
Jeong Kook Baek (MAJ, Armed Forces Ildong Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
Introduction
War has historically provided an opportunity for medical advancement and innovation. Military
medical personnel face the challenge of managing a high volume of severe multisystem injuries,
relative to what is encountered in civilian practice.
Korea is still exposed to North Korea’s threats. Military medicine in Korea always prepares for
treating patients who may arise in combat situations. Moreover, orthopedic surgeons are getting
important in combat injuries, because the effect of using advanced personal protective equipment
and enhanced armored vehicles decreased the injuries of thorax, abdomen and the incidence of
extremity injuries accounted for a higher percentage of all combat injuries. In same reasons, sol-
diers who in previous conflicts would have succumbed to injuries in the battlefield now are sur-
viving but have sustained devastating orthopedic injuries that require extensive treatment. Combat
orthopedic trauma patients in Korea on 2016 were two who treated at civilian hospitals. Now this
paper presents the cases who treated in 2016 and long-term follow-up results in 2015 combat or-
thopedic trauma.
Mechanisms of injury
During the major military conflicts of the 20th century, the incidence of gunshot-related combat
injuries declined, whereas the incidence of trauma resulting from blast mechanisms, such as artil-
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lery shell, landmine, or grenade, increased. One study demonstrated that 81% of all combat-related
injuries and 73% of all musculoskeletal injuries were precipitated by explosive blasts.
There were 4 casualties in 3 blast injuries and 2 gunshot injuries in 2015. Three blast injuries
were all by landmine mechanisms which one was PMD series mine by North Korea, another was
M14 anti-personnel mine, and the other was M15 anti-tank mine. There were 2 casualties in 2 blast
injuries in 2016. One blast injury was by landmine (M14 anti-personnel mine) during the combat
training. The other blast injury was by an explosive bomb accident during the combat training.
Types of Musculoskeletal injury
Of all combat casualties, 77% sustained at least one orthopedic injury, and fractures represented
40% of all musculoskeletal injuries, and amputations comprised 6% of all such injuries (Figure 1).
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In 2015 cases, we experienced 2 major traumatic amputations by PMD series mines, soft-tissue
injuries with subtalar joint dislocation by M14 anti-personnel mine and open distal femur fracture
with soft-tissue injuries in face, hand and knee by M15 anti-tank mine.
Fortunately, there were only 2 blast injuries in 2016. One case was below knee(BK) amputation
by M14 anti-personnel mine and the other was Chopart amputation with burns all over his body.
Primary (Completion) Amputation
In traumatic limb amputations, the nonviable distal portion is often attached to the proximal
portion by a small skin bridge or a few intact tendons that span a segment of lost tissue. Tran-
secting such bridging tissue is called a primary or completion amputation. Primary amputation is
indicated if the limb cannot be reconstructed or salvaged. This procedure is occasionally done in
the emergency department, but it is typically performed during the first visit to the operating room.
Other indications for primary (completion) amputation include: (1) ischemic limbs with irreparable
vascular injury; (2) hemorrhage control refractory to other means; and (3) enabling lifesaving resus-
citation in a patient whose injury physiologic burden (e.g., ongoing shock, hypothermia, acidosis,
coagulopathy, or infection) will not permit limb salvage. The latter exemplifies when limb-salvage
techniques are beyond the physiologic capacity of the patient.
Delayed Amputation
Indications for delayed limb amputation may include complications like refractory wound sepsis,
failed flap coverage or limb salvage (due to vascular or musculoskeletal causes), and selective am-
putation to optimize limb function (e.g., relieve pain or prosthetic fitting). Selective amputation is
performed when the distal salvaged limb function is less than that with a prosthetic. This decision
is typically deferred to the definitive treatment facility after discussion with the casualty. Standard,
conventional amputation levels were developed mostly from patients with diabetic vasculopathies.
These standard civilian-based practices do not apply to most combat casualties. Positive outcomes
have been documented for amputees undergoing delayed surgical amputations of atypical configu-
rations (level and flaps). Atypical surgical amputations do not employ standard or traditional levels
of bony cuts, standard (textbook) skin incisions, or typical musculofascial flaps to cover the cut
bone and conform to conventional prosthetic fittings.
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Reference
1. Schoenfeld AJ: The history of combat orthopaedic surgery, in Owens BD, Belmont PJ Jr,
eds: Combat Orthopaedic Surgery: Lessons Learned in Iraq and Afghanistan. Thorofare, NJ,
SLACK Incorporated, 2011, pp3-12.
2. Schoenfeld AJ: Orthopedic surgery in the United States Army: A historical review. Mil Med
2011; 176(6): 689-695.
3. Defense Casualty Analysis System: Department of Defense. Available at: https://www.dmdc.
osd.mil/dcas/pages/ summary_data.xhtml. Accessed March 11, 2016.
4. Owens BD, Kragh JF Jr, Macaitis J, Svoboda SJ, Wenke JC: Characterization of extremity
wounds in Operation Iraqi Freedom and Operation Enduring Freedom. J Orthop Trauma
2007;21(4): 254-257.
5. Belmont PJ Jr, McCriskin BJ, Hsiao MS, Burks R, Nelson KJ, Schoenfeld AJ: The nature and
incidence of musculoskeletal combat wounds in Iraq and Afghanistan (2005-2009). J Orthop
Trauma 2013; 27 (5): e107-e113.
6. Schoenfeld AJ, Laughlin MD, McCriskin BJ, Bader JO, Waterman BR, Belmont PJ Jr: Spinal in-
juries in United States military personnel deployed to Iraq and Afghanistan: An epidemiolog-
ical investigation involving 7877 combat casualties from 2005 to 2009. Spine (PhilaPa 1976)
2013; 38(20): 1770-1778.
7. Schoenfeld AJ, Dunn JC, Belmont PJ: Pelvic, spinal and extremity wounds among com-
bat-specific personnel serving in Iraq and Afghanistan (2003-2011): A new paradigm in mili-
tary musculoskeletal medicine. Injury 2013; 44(12): 1866-1870.
8. Schoenfeld AJ, Newcomb RL, Pallis MP, et al: Characterization of spinal injuries sustained by
American service members killed in Iraq and Afghanistan: A study of 2,089 instances of spine
trauma. J Trauma Acute Care Surg 2013; 74(4): 1112-1118.
9. Schoenfeld AJ, Dunn JC, Bader JO, Belmont PJ Jr: The nature and extent of war injuries sus-
tained by combat specialty personnel killed and wounded in Afghanistan and Iraq, 2003-
2011. J Trauma Acute Care Surg 2013; 75(2): 287-291.
10. Belmont PJ Jr, Goodman GP, Zacchilli M, Posner M, Evans C, Owens BD: Incidence and
epidemiology of combat injuries sustained during “the surge” portion of operation Iraqi Free-
dom by a U.S. Army brigade combat team. J Trauma 2010; 68(1): 204-210.
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11. Belmont PJ Jr, Thomas D, Goodman GP, et al: Combat musculoskeletal wounds in a US
Army Brigade Combat Team during operation Iraqi Freedom. J Trauma 2011; 71(1): E1-E7.
12. Schoenfeld AJ, Goodman GP, Burks R, Black MA, Nelson JH, Belmont PJ Jr: The influence
of musculoskeletal conditions, behavioral health diagnoses and demographic factors on inju-
ry-related outcome in a high-demand population. J Bone Joint Surg Am 2014; 96(13): e106.
13. Goodman GP, Schoenfeld AJ, Owens BD, Dutton JR, Burks R, Belmont PJ Jr: Nonemergen-
torthopaedic injuries sustained by soldiers in Operation Iraqi Freedom. J Bone Joint Surg Am
2012; 94(8): 728-735.
14. Masini BD, Owens BD, Hsu JR, Wenke JC: Rehospitalization after combat injury. J Trauma
2011; 71(1 suppl): S98-S102.
15. Masini BD, Waterman SM, Wenke JC, Owens BD, Hsu JR, Ficke JR: Resource utilization and
disability outcome assessment of combat casualties from Operation Iraqi Freedom and Oper-
ation Enduring Freedom. J Orthop Trauma 2009; 23(4): 261-266.
16. Owens BD, Kragh JF Jr, Wenke JC, Macaitis J, Wade CE, Holcomb JB: Combat wounds in
operation Iraqi Freedom and operation Enduring Freedom. J Trauma 2008; 64(2): 295-299.
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Symposium 9 - The Future of Military Trauma Care, Patient First in Military Trauma
Jang-Kyu Choi (MAJ, Armed Forces Capital Hospital)
2007.3~2011.2 Yonsei Univ. School of Medicine
2011.3~2012.2 The Armed Force Capital Hospital, 교육수련부
2012.3~2016.2 Seoul National Univ. Bundang Hospital Department of Surgery
2016.3~2017.2 Seoul National Univ. Bundang Hospital Department of Surgery
2017.3~ The Armed Force Capital Hospital Department of Surgery
Education
Career
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Symposium 9 - The Future of Military Trauma Care, Patient First in Military Trauma
Epidemiology of Burn in Military
Jang-Kyu Choi (MAJ, Armed Forces Capital Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
Backgrounds: We investigated the burn epidemiology, clinical differences and degree of tissue
injury to burn types. Such data can propose proper educational program designs to suit the com-
munity.
Methods: We had a retrospective clinical analysis of 908 acute burns for 7 year period (2010∼
2016). These included patient demographics, causes, tools of injuries and result of treatment.
Results: The male was predominant(905;99.7%). The young soldiers(752;82.8%), mean age of
20.6 yo, were the common victims. The flame burns(FB: 325;35.8%) was the most common and
followed scald burns (SB: 305; 34.6%), contact burns(CB: 219;24.1%), electric burns(EB: 45; 5.0%)
and chemical burns(ChB): 14;1.5%). The episode showed no seasonal or annual differences. CB
was most common in winter and EB in autumn.
SB had average 3.9% TBSA . Most of them were superficial(251; 82.3%) by spillage of hot
water/liquid food on lower leg(138; 45.2%) or foot.(102; 33.4%). Most were treat by simple dress-
ing(283; 92.8%). The 16(5.2%) showed wound hypertrophy and 4(1.3%) received burn skin care.
FB had relatively large wound of 9.3%. The 209(64.3%) had superficial wound by catching fire
to flammable oils(105; 32.3%) such as gasoline, solvent or to bomb powders(95; 29.2%) on head
and neck(195; 60.0%) or hands(188; 57.8%). They underwent simple dressing(271;83.4%) and
allogtafts or flap surgery(53;163%). The 41(12.6%) showed wound hypertrophy and 25(7.7%) re-
ceived burn skin care. There were 12(3.7%) corneal erosion or burns. The mortality rate was 1.2%(4
patient).
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CB had small(1.1% TBSA), deep wound(172;78.5%) by application of hotpacks(176;80.4%) to
nude skin of lower leg(176; 80.3%). The more(133;60.7%) were treat by allogtaft or flap surgery.
But they had rare sequelae.
ChB had 3.8% TBSA. The most of wounds were superficial(13; 92.9%) and treated well.
EB had 6.8% TBSA. They had serious wound by touch to high tension live line(32; 71.1%).
They had lots of complications; LOC(6:13.3%), nerve injuries(5;11.1%), major amputations(1; 2.2%).
The 2(4.4%) showed wound hypertrophy and received burn skin care.
Conclusions: The cook should put on protector below the boots at the dining room. The light-
er or smoking should be strictly prohibited during work by flammable liquids or bomb powders.
Teaching of not to apply the hotpack on nude skin is very important. The hight tension live line is
always very dangerous.
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Symposium 9 - The Future of Military Trauma Care, Patient First in Military Trauma
Hohyung Jung (CPT, Armed Forces Capital Hospital)
Ph.D. , Graduate School of Medicine (Emergency Medicine), Pusan National University
M.D. , Pusan National University College of Medicine
Fellowship, Department of Emergency Medicine, Pusan National University Yangsan
Hospital
Residency, Department of Emergency Medicine, Pusan National University Hospital
Korean Society of Emergency Medicine
Korean Society of Critical Care Medicine
Society of Emergency & Critical Care Imaging (SECCI)
Korean Society of Traumatology
Korean Society of Disaster Medicine
Korean Society of Echocardiography
Academic
Qualifications
Postgraduate
Ttaining
Academic
Membership
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What’s New in Traumatic Hemorrhagic
Shock
Hohyung Jung (CPT, Armed Forces Capital Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
What’s New in Traumatic Hemorrhagic ShockThe Armed Forces Capital HospitalDepartment of Emergency Medicine
Captain, Hohyung Jung (M.D. PhD)
Overview What’s New?
• “ Stop the bleed “ and Bleeding control (B-CON)• Tranexamic acid (TXA)• Hemostatic monitoring – VHA (TEG, ROTEM)• Massive transfusion ratios (1 : 1 : 1)• Prehospital blood and plasma• REBOA – aortic balloon occlusion
What’s on the horizon?• Freeze –dried plasma• Self-expending foam
Objectives Describe current best practices and future directions in resuscitation of traumatic hemorrhagic shock
Disclosures
• Some treatment not yet be approved
• Speaker has no financial disclosures
Hemorrhagic Shock : the problem Mortality from major trauma is a worldwide problem.
Massive hemorrhage (non-compressible) is the major cause of preventable death in both military and civilian trauma.
Development of coagulopathy further substantially increases mortality.
Early control of bleeding and coagulopathy reduce morbidity and mortality in trauma hemorrhage
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Hemorrhagic Shock : classification
Coagulopathy in Trauma
Key target for diagnosis and aggressive treatment in the bleeding phase
Pathophysiology
• Acute traumatic coagulopathy (ATC)
• Coagulopathy in the lethal triad
• Consumptive coagulopathy
Acute Traumatic Coagulopathy (ATC)
Traumatic endotheliopathy-> endogenous anticoagulation
Endogenous anticoagulation
• Auto-heparinization
• Protein C activation
• Hyperfibrinolysis : important cause of severe hemorrhage
Hemorrhagic Shock Two forms of blood loss from trauma
1) Direct or anatomic bleeding from the site of injury
• Compressible
• Non-compressible
2) Early coagulopathic bleeding
Mageale et al, Dtsch Arztebl Int 2011
Dobson et al, J Trauma 2015
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Coagulopathy in the Lethal Triad
Mageale et al, Dtsch Arztebl Int 2011
Damage Control Resuscitation
Consumptive Coagulopathy
Coagulation factors, platelet consumption
Prothrombotic state of the microvasculature
Inflammatory response
Sympatho-adrenal overactivation : catecholamine
Hemorrhagic Shock : the solution Mechanical hemorrhagic control
• External bleeding : tourniquet, hemostatic dressings
• Internal bleeding (non-compressible) : interventions
Damage control resuscitation (DCR)
• Hemostatic resuscitation
• Permissive hypotensive resuscitation
• Regaining homeostasis and avoid further coagulopathy
What’s New? “ Stop the bleed “ and Bleeding control (B-CON)
Tranexamic acid (TXA)
Hemostatic monitoring – VHA (TEG, ROTEM)
Massive transfusion ratios (1:1:1)
Prehospital blood and plasma
REBOA – aortic balloon occlusion
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B-CON
Bleeding control course for non-EMS (bystander)
Bleeding control should be the CPR of 21th century
Bleeding Control Kit Pre-hospital Hemostatic Dressings
Granville-Chapman et al, Injury 2010
Tranexamic acid (TXA) Prevent fibrinolysis (clot
breakdown)
Promote appropriate
coagulation
Lysine analogue
Many, many studies in
different surgical populations
Mannucci et al, NEJM 2007
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TXA in Trauma Landmark studies
• CRASH-2 (worldwide)
• MATTERS (military)
Up to 14% improvement in survival (MTP)
1 extra survivor every 8 patients
MATTERS : less coagulopathy after TXA
Viscoelastic hemostatic assays (VHA)
Hemostatic monitoring – whole blood
• Thromboelastography (TEG)
• Rotational Thromboelastometry (ROTEM)
Rapid identification(< 30min) of coagulopathy and individualized, goal-directed transfusion therapy
Early identification of patients who will require MT
CRASH-2 : improved survival with TXA
MATTERS : improved survival with TXA
Viscoelastic hemostatic assays (VHA)
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Viscoelastic hemostatic assays (VHA)
Johansson et al, Blood 2014
ROTEM
Schöchl et al, SJTEM 2012
a. Normal test result b. Reduced MCF c. Delayed initiation of coagulation
d. Prolonged CT and reduced MCF e. Hyperfibrinolysis
Massive Transfusion Protocols (MTPs)
Improve survival in traumatic shock
Mortality absolute risk reduction 15 – 20%
Lower crystalloid and blood product requirement
But inherent risks of blood product transfusion
TEG
VHA impact on outcomes
Improved survival
Reduction in blood product transfusion and thromboembolic events
Earlier shift from empiric to goal-directed transfusion strategy
Massive Transfusion Protocols (MTPs)
Bogert et al, Journal of Intensive Care 2014
Transfusion package
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Massive transfusion ratios 1:1:1 vs 1:1:2
FFP : PLT : PRBC
High FFP : PRBC associated with lower mortality
~20% improvement in survival
1 extra survivor in 5 patients
Newer concepts in hemostatic resuscitation
Pre-hospital TXA ?
Pre-hospital blood products?
Plasma or PLT first ?
Retrospective cohort study Improved 24hr survival Improved shock parameters Decreased in-hospital transfusion requirements Overall survival not improved
Massive transfusion ratios
PROMMTT study (Holcomb, JAMA Surg. 2013)• 1 : 1 : 1 = improved 6hr survival• No 24hr survival benefit
PROPPR trial (Holcomb, JAMA 2015)• 1 : 1 : 1 = less death from hemorrhage• No 24hr or 30 day survival benefit
Optimal ratio is probably between 1 : 1 : 1 ~ 1 : 1 : 2
Retrospective cohort study Improvement in Vital functions TCA : High ROSC rate, but no survivors
Pre-hospital Blood Product RCTsName Full Product Control Country N Stage
PUPTH Pre-hospital Use of Plasma in Traumatic Hemorrhage
Thawed FFP
Standard care (0.9% NS) USA(Virginia)
210 Recruiting
PAMPer Pre-hospital Air Medical Plasma
Thawed FFP
Standard care (0.9% NS) USA(Pittsburg)
600 Recruiting
COMBAT Control Of Major Bleeding After Trauma
Thawed FFP
Standard care (0.9% NS) USA(Denver)
150 Recruiting
RePHILL Resuscitation with Pre-hospItaL bLoodproducts
1:1 pRBCand LysoPlas N-w
Standard care (0.9% NS) UK(Birmingham)
490 Recruiting
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REBOA Resuscitative Endovascular Balloon Occlusion of Aorta
Not new, first reported in the 1950s during the Korean War
But renewed, alternative to resuscitative thoracotomy
Abdominal or pelvic hemorrhage, not thoracic
Temporary control of arterial inflow
Bridge the gap between shock and definite care
REBOA : vs resuscitative thoracotomy
Hemostatic Resuscitation
Stensballe et al, Curr Opin Crit Care 2016
REBOA : devices
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REBOA : techniques1. Arterial access and positioning of sheath
2. Selection and positioning of the balloon• Using surface anatomic land mark• Zone I : xiphoid process• Zone III : umbilicus
3. Inflation of the balloon
4. Deflation of the balloon
5. Sheath removal
REBOA : position confirmation
Zone I : T4~L1 Zone III : L2~L4
X-ray
REBOA : “Safe” occlusion time? Partial-REBOA (P-REBOA)
• permissive regional hypoperfusion
Unknown….
Zone I (supra-celiac) : 30 ~ 45 min
Zone III (infra-renal) : 60 ~ 90 min
REBOA : aortic zones Zone I : descending thoracic aorta,
origin of the left subclavian~ celiac arteries
Zone II : paravisceral aorta, celiac ~ the lowest renal artery
Zone III : infrarenal abdominal aorta,the lowest renal artery ~ the aortic bifurcation
Select zone of occlusion based on injury pattern
Zone I & III preferred, avoid occlusion in Zone II
REBOA : position confirmation
Fluoroscopy Ultrasound
REBOA : algorithm for arrest
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REBOA : algorithm for shock
REBOA outcomes
Perkins et al , Curr Opin Crit Care 2016
60min
REBOA : does it work? Probably.…?
Which patients ?
Contraindications ?
Torso ischemia, reperfusion injury
Femoral puncture site morbidity, distal clot
Therapeutic effect ?
Risk of severe complications and iatrogenic harm
REBOA outcomes
Perkins et al , Curr Opin Crit Care 2016
38%
REBOA outcomes
Perkins et al , Curr Opin Crit Care 2016
Balloon inflation/deflation
REBOA : which patients? where?
Exsanguinating non-compressible torso hemorrhage
Sub-diaphragmatic
Pre-hospital
Emergency department
OR
ICU
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REBOA : summary REBOA feasible ED and Pre-Hospital setting
Wide range clinicians can perform
Potentially life saving
Partial-REBOA important
Therapeutic effect ?
Risk of severe harm
Many unanswered questions….
Freeze-dried plasma
French Army experience
US Army pilot project
Longer shelf-life (2 yrs vs 1 yr)
No need for refrigeration
Appears to be effective
Freeze-dried plasma equivalence to FFP
Pig model of hemorrhagic shock
Shuja et al, J Trauma 2008
On the horizon
Freeze-dried plasma
Self-expanding foam
Freeze-dried plasma
Self-expanding foam
Polyol + isocyanate phases mixed during injection
Duggan et al, J Trauma 2013
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Self-expanding foam : concept
Rapid expansion Conforms to abdominal structures Solidifies Then operate
Self-expanding foam : animal studies
Duggan et al, J Trauma 2013
Self-expanding foam : animal studies
Duggan et al, J Trauma 2013
Self-expanding foam : pig studies
Duggan et al, J Trauma 2013
Self-expanding foam : animal studies
Duggan et al, J Trauma 2013
Self-expanding foam : animal studies
Dose dependent survival benefit in an animal model
Peev et al, J Trauma 2014
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Summary Hemorrhage remains a leading cause of death
Hemorrhage control and resuscitation begins in field and continues in Bay
• B-CON, TXA, prehospital FFP/PLT/PRBC. 1 : 1 : 1 massive transfusion, VHA (TEG, ROTEM), REBOA
Evolving techniques are promising
• Freeze-dried plasma
• Self-expanding foam
Thank you !
The sooner you stop bleeding,
the better your patient’s outcome
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Symposium 9 - The Future of Military Trauma Care, Patient First in Military Trauma
Kurt Edwards (COL, San Antonio Military Medical Center)
Chief of Trauma and Surgical Critical Care-San Antonio Military Medical Center
2015 to Present
Chief of General Surgery-San Antonio Military Medical Center 2015
Co-Director Surgical and Trauma ICU - San Antonio Military Medical Center
2014-2015
Trauma Fellowship, University of Hawaii, Honolulu, HI / 2007-2008
Program Director: Dr. Hao Chih Ho
Surgical Critical Care Fellowship, University of Hawaii, Honolulu, HI / 2006-2007
Program Director: Dr. Mihae Yu
General Surgery Residency, Eisenhower Army Medical Center, Fort Gordon, GA
2001-2005
1983-1988
Examiner-2012, 2011, 2009
Postoperative Fluid and Electrolytes- Tripler Army Medical Center Cardiac
Nurse Course Dec 2009, Jul 2012
Member American Association of Trauma Since 2013
Fellow American Board of Surgeons Since 2010
Member Society of Critical Care Medicine 2007
Board Certified Surgical Critical Care October 1, 2007 Expires July 2018
Board Certified General Surgery March 21, 2006 Expires 2028
Positions
Academic
Education
Licensure/
Certification
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Sharing Experience of Forward Surgical
Team in Afghanistan
Kurt Edwards (COL, San Antonio Military Medical Center)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
Background: The previous United States Secretary of Defense Robert Gates on finding casu-
alty fatality rates being higher in Afghanistan than Iraq in 2009 issued a requirement that military
units be within one hour of surgical care. This resulted in a flourishing of Forward Surgical Teams
throughout Afghanistan. Colonel Kurt D. Edwards has deployed five times with these small units
to Afghanistan. Colonel Edwards will attempt to give his perspective and lessons learned operat-
ing within these small unit surgical teams.
Learning Objectives:
1. Overview of the US Army Forward Surgical Team organization currently and in the future.
2. Review the challenges with the current organization and deployment of Forward Surgical
Teams.
3. Review, through film, and personal experienced the lessons learned operating in small surgi-
cal units in austere environments with such procedures as:
a. Resuscitation
b. Craniectomies
c. Blast injuries
d. Extremity vascular trauma
e. Pediatric trauma
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Conclusion: The proof that forward surgical teams within one hour of casualties improve out-
come is equivocal their perceived success ensures their continued high utilization. This should
prompt improvements in organization, training, and equimpment.
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
Director
Chan Yong Park (Pusan National Univ. Hospital)
Moderator
Myung I Choi (Chonnam National Univ. Hospital)
Kyung Hag Lee (National Medical Center)
1F. Seminar 2
Symposium 7
Nursing Roles in Trauma Center
06-24 (Sat.), 2017
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Symposium 7 - Nursing Roles in Trauma Center
Sun Mi Kim (Pusan National Univ. Hospital)
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Trauma Bay
Sun Mi Kim (Pusan National Univ. Hospital)
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Symposium 7 - Nursing Roles in Trauma Center
Kyung Mi Kim (Dankook Univ. Hospital)
March 2011 Graduate School of Health and Welfare, Dankook Univ.
August 2013 Graduate School of Health and Welfare, Dankook Univ.(Master of
Nursing)
July 2014 Obtained Elderly Professional Nurse Qualification
September 2017 Graduate School of Health and Welfare, Dankook
University(Doctor of Nursing)
September 1999 Joined Dankook University Hospital
June 2017 Currently working in Dankook University
Education &
Job Experience
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Trauma Intensive Care Unit
Kyung Mi Kim (Dankook Univ. Hospital)
The 5th Pan Pacific Trauma Congress
The 32nd Annual Meeting of the Korean Society of Traumatology
Intensive care nursing will threaten living things.
This fact was revealed in the 1950s and 1980s.
Since then, with the advancement of medical and medical technology, patients have become increasingly complex, and nurses have become increasingly specialized knowledge and skills
As the delivery system has been evolving to enable continuous surveillance and treatment for serious patients, critical care nursing, an essential element, continues to evolve.
The American Association of Critical-Care Nurses (AACN) defines critical care as “an area of nursing that addresses human response to life-threatening illnesses.” Intensive care unit (ICU) re-fers to patients whose actual or potential health problems are life-threatening.
The higher the severity, the more unstable and dangerous the patient will need, and the more intensive nursing you need to watch 24 hours a day.
Like other medical areas, ICU nursing is undergoing a rapid change process, and the challenges facing ICU nursing are much greater than ever in the 21st century.
There are many areas where ICU nursing care can contribute to revitalizing the health care de-livery system that is led by the patient and the family in critical situations.
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Although patients in critical condition are the main target of ICU care, interest in helping the patient’s family to have the ability to help patients is increasingly increasing, and the degree of in-volvement of ICU families in ICU nursing is increasing.
The role and tasks that nurses should perform are presented
At the heart of critical care is the use of critical thinking to maintain careful balance of care.
In terms of the holistic framework, human beings can not be thought of as part of an integrated physiological, mental, spiritual, and social beings.
In order to provide holistic care, an intensive care nurse should understand the following key concepts needed to understand patients and their families and provide mediation to them.
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Symposium 7 - Nursing Roles in Trauma Center
Myung Jin Jang (Gachon Univ. Gil Hospital)
Cheju Halla Univ. Department of Nursing Science (Professional Bachelor)
Korea National Open University (Bachelor)
Inha Univ. Hospital Department of Nursing Science (Master's Degree)
Gachon Univ. Gil Hospital (Dedicated Nurse)
Education
Career
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Physician Assistant
Myung Jin Jang (Gachon Univ. Gil Hospital)
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Symposium 7 - Nursing Roles in Trauma Center
Sang Mi Noh (Chonnam National Univ. Hospital)
Chonnam National University, College of Nursing, Gwangju - Master in Nursing (2016 ~ )
Lehman College, Bronx, New York - Bachelor of Science in Nursing, 2009
Dongkang College, Kwangju, Korea - Associate degree in Nursing, 2004
North Central Hospital, Bronx, New York ( RN-BSN Course, 2009 )
- Clinical Practice in Telemetry Unit , ER and OR
Jacobi Medical Center, Bronx, New York ( RN-BSN Course, 2009 )
- Clinical Practice in Telemetry Unit & CCU
Dong-A Hospital (Korea)
- Worked in Endoscopy Room & the Surgical Department (From 2005 to 2006)
Moa Hospital (Korea)
- Delivery Room (From 2004 to 2005, 2010 to 2012)
Chonnam National University Hospital (Korea)
- Worked at Trauma Center as Program Manager and Register (From 2012 to Present)
Education
Experience
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Registry
Sang Mi Noh (Chonnam National Univ. Hospital)
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Symposium 7 - Nursing Roles in Trauma Center
Byungchul Yu (Gachon Univ. Gil Hospital)
1998-2004 Medical Doctor
Gachon Medical School, Inchoen, Korea
2004-2009 Resident Gachon University Gil Medical Center
2009-2012 Chief of General Surgery Department Armed Forced Wonju Hospital
2012-2014 Fellowship of Trauma Surgery Gachon University Gil Medical Center
2016- Assistant Professor Gachon University Gil Medical Center
Education
Professional
Positions
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Performance Improvement
Byungchul Yu (Gachon Univ. Gil Hospital)
The 5th Pan Pacific Trauma Congress
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Symposium Abstract
Published on June 21st, 2017
Publisher │ Ho-Seong Han
Chief Editer │ Sung-Hyuk Choi
The Korean Society of Traumatology
Hyundai Venture-Vill #528, 10, Bamgogae-ro 1-gil,
Gangnam-gu, Seoul, Korea
TEL : +82-2-364-5119
FAX : +82-2-459-8256
E-mail : [email protected]
The 5th Pan Pacific Trauma CongressThe 32nd Annual Meeting of the Korean Society of Traumatology
DERMABOND PRINEO® Skin Closure System Strength and protection for excellent wound closure
COPY-15003-ET
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나제아는 수술 후 오심·구토를 강력하고 지속적으로 억제합니다
AN
A-1
5-A
-01
•나제아 주사액은 다양한 종류의 수술 후 오심 및 구토에 효과적입니다.1)
•나제아 주사액은 1일 1앰플로서 24시간 제토효과가 유지됩니다.2)
(24시간 내 2앰플까지 증량 가능합니다.)
•나제아 주사액은 항 구토 작용이 강력한 R체만의 순수한 5-HT3 수용체 길항제 입니다.3)
1) Hahm TS et al, Anaesthesia 2010 May;65(5);500-4 / Kwak YL et al, Spine. 2008 Aug 1:33(17):E602-62) Nasea Package insert3) Miyata K et al, J pharmacol Exp Ther. 1991 Oct:259(1):15-21
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