Management of Major Burn Patients with Multiple Rib Fractures: 2 Case Report

About 5% of burn patients come with other injuries. When patients with multiple rib fractures are put under general anesthesia, there is a higher rate of a variety of complications, such as hemothorax, pneumothorax, lung contusion, and etc. Also, symptoms of the complications are likely to get worse. Therefore, it is important to decide when it is appropriate to perform surgery. Our hospital delayed operation time on two burn patients who had multiple rib fractures and then performed surgery under general anesthesia, treating patients without any particular complications.

A Case of Pumpless Extracorporeal Interventional Lung Assist Application in a Patient with Severe ARDS Who Is Severe Burn with Inhalation Lung Injury: A Case Report

A 35 year old male patient with inhalation injury including 45% body surface area burn was transferred to the hospital. After 2 days of hospitalization lung protective ventilation was supported due to acute respiratory distress occurrence. Fifth day the patient suffered hypercapnea which was uncontrollable with mechanical ventilators. Interventional lung assist (iLA) was proceeded on the tenth day, and the patients hypercapnia symptom was compatible with lung protective ventilation at the time, but the patient eventually suffered death after 12 days of treatment and care in the hospital.

NEXUS and the Canadian Cervical Spine Rule as a Screening Tool for Computed Tomography Evaluation in Patients with Cervical Spine Injury

PURPOSE: National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian Cervical Spine rule (CCR) are commonly used in cervical trauma patients to determine whether a plain cervical X-ray should be performed. However, plain cervical X-rays are so inaccurate that cervical spine computed tomography (CT) is often considered as a screening test. We studied the usefulness of the NEXUS criteria and the CCR for determining the need for a CT evaluation in the emergency department (ED). METHODS: This prospective observational study was conducted from January 2007 to March 2008. Plain Xray and CT scans of the cervical spine were performed on blunt trauma patients with neck pain. The relevancy of CT was examined using the NEXUS criteria and the CCR. Sensitivity, specificity, positive predicted value, and negative predicted value analyses were performed to diagnose the cervical spine injury. RESULTS: During the study period, 284 patients were enrolled in this study. The sensitivity, specificity, positive predicted value, and negative predicted value of the NEXUS criteria were 87.5%, 1.1%, 5.0%, and 60.0% respectively, while those of the CCR were 87.5%, 8.2%, 5.3%, and 91.6%. There were two missed fracture cases when the NEXUS criteria and the CCR were applied independently, however, no cases were missed when both were applied. CONCLUSION: This study suggests the NEXUS and the CCR in combination can be used as a guide to CT evaluation for cervical spine injury in the ED.