Heat-related illnesses (HRIs) represent an increasingly critical threat to the health and operational readiness of the Republic of Korea (ROK) Armed Forces. Rising global temperatures, combined with Korea's humid summers and intensive military training, have increased both the incidence and severity of HRIs among soldiers. This paper provides a comprehensive review of HRIs in the ROK military, beginning with an overview of their pathophysiology and classification, ranging from heat cramps to exertional heat stroke-the most severe and life-threatening form. We then examine recent epidemiological trends, which reveal over 1,200 documented cases between 2018 and 2023, with new recruits disproportionately affected. A comparative analysis across service branches indicates that Army personnel, who engage in high-intensity outdoor training, bear the greatest burden, while Navy and Air Force members face distinct occupational exposures in engine rooms and on airfields, respectively. The risk in the ROK military is striking in international comparison: odds ratios suggest that soldiers face more than 27 times the risk of HRIs compared with the civilian population, exceeding reported burdens in allied militaries such as the United States and Japan. Lessons from other nations, particularly the use of real-time surveillance, wearable technologies, and structured acclimatization programs, offer valuable models for ROK. Preventive strategies must therefore extend beyond medical management to include leadership accountability, environmental engineering, digital monitoring, and a cultural shift that promotes reporting. In an era of accelerating climate change, HRIs must be reframed not only as medical conditions but also as preventable threats to combat readiness, soldier welfare, and national security.
Purpose:The objective of this study was to describe the epidemiology, mechanisms of injury, and outcomes of vascular trauma patients admitted to an American College of Surgeons level I trauma center located in a predominantly suburban county on Long Island, New York, United States, and to compare these findings with the existing literature. Methods:This retrospective observational study used data collected from the hospital's trauma registry for all patients with documented vascular trauma between January 2015 and December 2023, identified through relevant ICD-9 and ICD-10 codes. Results:The trauma registry query identified 208 vascular trauma cases out of 12,617 total trauma cases (1.7%). The overall mortality rate was 19.7%, and the amputation rate was 2.4%. Patients were predominantly male, with a mean age of 40 years. Black and Hispanic patients were disproportionately affected. Most injuries were blunt, and these were associated with higher Injury Severity Scores (ISS), lower Glasgow Coma Scale (GCS) scores, and longer hospital length of stay (LOS). Multivariate analysis demonstrated a significant overall effect of mechanism of injury (blunt vs. penetrating) on ISS, GCS, and hospital LOS. Truncal injuries carried higher mortality than face/neck and extremity injuries. Conclusions:Although relatively uncommon, vascular trauma remains associated with significant morbidity and mortality, particularly in blunt mechanisms and truncal injuries. The findings highlight the importance of regional epidemiological surveillance and raise concerns about racial disparities. These results emphasize the need for targeted prevention efforts, improved resource allocation, and further research to address the social and clinical factors underlying poor outcomes in vascular trauma.
A previously healthy 41-year-old woman was admitted after being crushed beneath a forklift from the chest to the lower extremities, presenting with traumatic asphyxia. Initial evaluation revealed no apparent trauma to the head or neck, but multiple fractures from the chest to the lower extremities were diagnosed. The patient underwent emergent thoracoabdominal surgery with subsequent clinical improvement. However, 4 days after the accident, anisocoria developed, and neuroimaging confirmed ischemic stroke due to traumatic carotid artery dissection. Anticoagulation and lipid-lowering therapy were initiated, and the patient successfully underwent the remaining orthopedic procedures without hemorrhagic complications. This report emphasizes that traumatic carotid artery dissection may occur even in the absence of concomitant cervical or cranial injuries, highlighting the importance of considering vascular injury in patients with severe trauma regardless of the mechanism of injury.
A 5-year-old girl presented with an inability to abduct her left shoulder and flex her left elbow following a fall 1.5 months earlier. Electrodiagnostic studies were suggestive of a partial upper trunk brachial plexus injury. The child was advised to attend monthly follow-up visits with regular physiotherapy and nerve stimulation. At 3 months after injury, elbow flexion had recovered completely, and shoulder abduction had improved to 30°. After an additional month of observation without further clinical improvement in shoulder abduction, a nerve-to-triceps transfer to the axillary nerve was planned in the fifth month. Intraoperatively, the posterior division of the axillary nerve was found to be excitable. To preserve nerve continuity, an end-to-side supercharging procedure was performed using the nerve to the medial head of the triceps to augment the axillary nerve. The postoperative period was uneventful, and physiotherapy was resumed 3 weeks after surgery. Within 7 months of surgery, the patient demonstrated full shoulder abduction. Restoration of shoulder function is a primary goal in the management of brachial plexus injuries. Nerve transfers offer substantial potential for improved functional recovery. In this case, lateral neurorrhaphy of the nerve to the medial head of the triceps to the axillary nerve provided additional motor input, facilitating earlier deltoid recovery. Early surgical intervention in selected cases may contribute to faster and more effective recovery, particularly in the pediatric population.
Purpose Resuscitative endovascular balloon occlusion of the aorta (REBOA) effectively reduces uncontrollable torso hemorrhage in trauma. An open abdomen (OA) with temporary abdominal closure commonly follows damage control surgery in such cases. Early definitive fascial closure (DFC) is crucial to prevent complications such as enteric fistula, peritoneal abscess, or chronic ventral hernia. This study aimed to evaluate the effect of REBOA on DFC after massive traumatic hemorrhage. Methods This retrospective study analyzed 839 patients requiring massive transfusion at a level I trauma center between 2015 and 2022. Subgroup analyses were conducted among patients who underwent OA and DFC. Primary outcomes were DFC achievement and timing (≤48 hours vs. >48 hours). Secondary outcomes included various clinical outcomes. Results Of 229 patients meeting inclusion criteria, 76 (33.2%) required OA management, of whom 33 (43.4%) achieved DFC. The OA+ group demonstrated more severe injury (median Injury Severity Score, 34.0 vs. 22.0; P<0.001) and higher REBOA utilization (47.4% vs. 15.0%, P<0.001). Multivariate analysis showed that bowel perforation (adjusted odds ratio [OR], 6.75; 95% confidence interval [CI], 1.56–29.23; P=0.011) and Sequential Organ Failure Assessment (SOFA) score (adjusted OR, 0.58; 95% CI, 0.43–0.79; P<0.001) were independently associated with DFC achievement; REBOA use was not. Among patients achieving DFC, univariate analysis identified OA indication (OR, 0.11), number of laparotomies (OR, 0.16), and crystalloid volume (OR, 1.00) as factors associated with early closure (≤48 hours), though none remained significant in multivariate analysis. Conclusions Zone I REBOA did not significantly influence the achievement or timing of DFC following OA in trauma patients with massive hemorrhage. The deteriorating condition in REBOA recipients and the limited sample size may have affected these findings. Nevertheless, several clinical indicators were associated with DFC, suggesting potential utility in trauma care decisions.
Purpose Intertrochanteric femur fractures treated with proximal femoral nails (PFNs) may develop complications such as screw cutout, nonunion, and varus collapse, which can necessitate salvage procedures including hip arthroplasty. This study aimed to evaluate the surgical challenges, operative techniques, and outcomes of hip arthroplasty performed after failed PFN fixation. Methods A total of 59 patients who underwent hip arthroplasty following PFN failure for intertrochanteric femur fractures were enrolled. Collected data included patient demographics, fracture characteristics, PFN failure patterns, surgical techniques, complications, and functional outcomes. Results The most common PFN failure patterns were screw backout, cutout, screw breakage, and nail breakage. These cases were managed with salvage hip arthroplasty, including hemiarthroplasty and total hip arthroplasty, depending on patient-specific factors. Intraoperative challenges involved implant removal and management of bone defects. Reported complications included dislocation, deep vein thrombosis, and periprosthetic fractures. The mean Harris Hip Score at 24 months was 79.2. Conclusions Hip arthroplasty serves as an effective salvage option for failed PFN fixation in intertrochanteric femur fractures. However, it presents distinct surgical challenges and requires careful patient selection and meticulous technique to reduce the risk of complications.
Purpose Central venous catheterization and endotracheal intubation are critical lifesaving procedures, yet structured training opportunities remain limited and often rely on informal apprenticeships. This study evaluates the effectiveness of the Airway and Catheter Cannulation Education—from Starters to Specialists (ACCESS) program in improving procedural knowledge, confidence, and ultrasound proficiency. Methods Data from 70 healthcare professionals (38 residents, 28 specialists, and 4 others) who completed the ACCESS program between 2022 and 2025 were analyzed. Participants were divided into two cohorts: a retrospective cohort (n=46) from 2022 to 2023, who completed the post-training questionnaire only, and a prospective cohort (n=24) from 2024 to 2025, who underwent pre- and post-training assessments. The questionnaire used a self-reported 10-point Likert scale. Results Overall, 67 valid post-training responses were analyzed, excluding 3 incomplete surveys from the prospective group. Participants reported exceptional satisfaction, with clinicians (>6 years of experience) reporting higher satisfaction with equipment (P=0.020). In the prospective cohort (pre-training, n=24; post-training, n=21), significant improvements were observed across all domains (P<0.001). Ultrasound proficiency showed the most dramatic increase (from 4.67 to 8.81), accompanied by marked improvements in procedural confidence. Conclusions The ACCESS program effectively enhanced procedural competence, especially ultrasound-guided skills. The significant improvement observed in the cohort with a high percentage of specialists underscores the limitations of traditional models and highlights the critical value of standardized high-fidelity simulation training programs for physicians at all career stages.
Purpose Hepatic pseudoaneurysm (HPA) is a rare but potentially life-threatening sequela of liver trauma. This study aimed to evaluate the number of children diagnosed with HPAs following blunt and penetrating liver trauma at a major trauma center in London over a 5-year period. Methods A retrospective analysis was conducted of patients aged <18 years with liver injuries admitted to our institution between 2017 and 2022. Patients were identified through the local trauma registry. Data collected included patient demographics, imaging details (including ultrasound scanning and computed tomography [CT]), liver injury grade, and management plans. Results Thirty-four patients were identified (mean age, 12 years; range, 1–17 years). There were 26 men (76.5%) and 8 women (23.5%). Twenty-three patients (67.6%) sustained blunt injuries, and 11 (32.4%) sustained penetrating liver injuries. Among 30 patients (excluding 4 patients who died), 18 (60.0%) underwent repeat CT imaging. CT imaging identified four HPAs (13.3%), two of which were treated with embolization. Of the 12 patients who did not undergo repeat CT, 6 (50.0%) had follow-up ultrasound scanning. Conclusions Hepatic pseudoaneurysms following trauma are uncommon. Their management in the pediatric population presents challenges regarding follow-up imaging, particularly the use of CT. Although the absence of standardized protocols complicates surveillance strategies, an individualized approach informed by patient-specific factors is essential. Contrast-enhanced ultrasound may optimize HPA detection while minimizing radiation exposure.
Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic, and potentially fatal complication associated with the abrupt withdrawal of dopaminergic agents or the use of antidopaminergic medications that affect the hypothalamus and basal ganglia. Its hallmark features include severe hyperthermia, altered consciousness, skeletal muscle rigidity, and autonomic instability. We present the case of a young patient with a cervical spine injury who was admitted to the trauma intensive care unit (ICU). The patient developed a persistent high-grade fever that did not respond to standard interventions, which was ultimately attributed to NMS resulting from the administration of neuroleptic medications. Because of a high degree of clinical suspicion and the implementation of prompt therapeutic measures, the patient achieved a favorable clinical outcome. Early diagnosis and timely intervention are crucial in NMS due to its rapid clinical progression, particularly as the use of dopaminergic antagonists becomes more prevalent in ICU settings. This case highlights the diagnostic challenges of managing NMS alongside spinal trauma in the ICU, as NMS often mimics common postoperative and ICU-related complications, necessitating heightened clinical vigilance.
Purpose Minor head trauma is one of the most common reasons for pediatric emergency department visits. Accurate identification of children at risk for clinically important traumatic brain injury (ciTBI) is essential to reduce unnecessary computed tomography (CT) imaging. This study evaluated the diagnostic performance of the PECARN (Pediatric Emergency Care Applied Research Network) clinical decision rule in children with minor head trauma presenting to a tertiary care hospital in South India. Methods In this observational study conducted between September 2022 and April 2024, 235 children aged <18 years presenting with head trauma and Glasgow Coma Scale scores of 14–15 were prospectively enrolled. Participants were stratified into age-specific PECARN risk categories. Diagnostic performance was assessed against ciTBI outcomes defined by clinical and radiological criteria. Results The PECARN rule demonstrated strong diagnostic performance, with a sensitivity of 82.4%, specificity of 74.1%, and an area under the receiver operating characteristic curve of 0.90 (P=0.01). No cases requiring neurosurgical intervention were missed. Children aged ≥2 years had a higher incidence of ciTBI than those aged <2 years (13.4% vs. 1.8%, P=0.048). ciTBI was significantly associated with loss of consciousness, vomiting, severe headache, and signs of basilar skull fracture (all P<0.001). Conclusions The PECARN rule appears to be a reliable and safe tool for evaluating pediatric minor head trauma in Indian emergency settings. Its high sensitivity and negative predictive value support its use in reducing unnecessary CT imaging while accurately identifying children at risk for ciTBI.
We present a case of traumatic penile artery occlusion resulting in arteriogenic erectile dysfunction. A 34-year-old man was referred to the emergency department following a motorbike collision that caused pelvic trauma. Contrast-enhanced multidetector computed tomography revealed a complex pelvic fracture pattern, including pubic diastasis, fracture of the left sacral ala, and avulsion of the left ischiatic spine, along with penile artery occlusion and absence of homolateral cavernosal corpora blushes. Contrast-enhanced multidetector computed tomography is a comprehensive and precise imaging modality for evaluating pelvic trauma. Assessment of the penile artery and internal pudendal artery network is crucial in pelvic trauma cases to promptly identify arterial occlusion and facilitate timely evaluation and management of erectile dysfunction.
Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is widely used in trauma and emergency medicine for its rapid analgesic and sedative properties. While its efficacy in acute pain management is well established, concerns persist regarding its long-term psychological effects, particularly its potential role in the development of posttraumatic stress disorder (PTSD). Some studies indicate that ketamine may provide rapid symptom relief in PTSD, whereas others raise concerns about its contribution to dissociative states and maladaptive memory consolidation. This narrative review examines existing literature on ketamine’s influence on PTSD symptomatology in trauma-exposed populations. A comprehensive assessment of randomized controlled trials and observational studies was undertaken to explore ketamine’s effects on dissociation, memory processing, and long-term psychiatric outcomes. Relevant studies were identified from major medical databases, and findings were synthesized to present an integrated overview of ketamine’s psychological impact in trauma care settings. Clinical trials suggest that a single intravenous infusion of ketamine (0.5 mg/kg) may significantly reduce PTSD symptoms within 24 hours compared to midazolam, with improvements in overall clinical presentation and no lasting dissociative effects. Conversely, some observational studies have linked ketamine use in acute trauma care to heightened dissociation, hyperarousal, and stress symptoms during early follow-up. Research on burn patients receiving intraoperative ketamine suggests a possible reduction in PTSD incidence, although a later study reported no significant difference compared with non-ketamine controls. The relationship between ketamine and PTSD is complex, with effects appearing to depend on dose and timing of administration. While perioperative ketamine may confer protective benefits against long-term psychiatric sequelae, immediate post-trauma administration may worsen dissociative symptoms and acute stress responses. Further well-controlled clinical trials are needed to refine dosing protocols and identify patient-specific risk factors, including preexisting psychiatric conditions, to better guide its use.
Sternoclavicular joint (SCJ) dislocation is a rare but serious orthopedic injury, representing fewer than 1% of all fractures or dislocations. Posterior dislocations are particularly concerning due to the SCJ's proximity to vital structures such as the trachea, esophagus, subclavian vessels, and brachial plexus. Clinical suspicion should be heightened when a patient presents with a compression-type injury to the shoulder girdle and pain around the SCJ. We report the case of a 12-year-old boy who presented to the emergency department after being punched in the right shoulder by another child, resulting in severe pain and an inability to move his right shoulder. Clinical assessment raised suspicion for a posterior SCJ dislocation, which was confirmed by computed tomography scan. The rarity of this condition in pediatric patients, coupled with the potential for severe complications, underscores the significance of this case for clinical recognition and management.
As the global population ages, acetabular fractures are increasingly diagnosed in older adults. These injuries, often caused by low-energy trauma, present treatment challenges due to reduced bone quality and the presence of comorbidities. Surgical fixation is frequently required to restore mobility and prevent long-term disability. In some cases, however, associated abdominopelvic injuries may remain occult until discovered intraoperatively. We report the case of a 67-year-old woman who sustained an acetabular fracture after a fall from height. During internal fixation using the modified Stoppa approach, an undetected peritoneal rupture was identified. This case underscores the importance of careful preoperative evaluation and preparedness for intraoperative collaboration with abdominal surgery teams, particularly when subtle abdominal signs are present.
Blunt traumatic pericardial rupture is an exceptionally rare condition, often associated with high morbidity and mortality. Isolated pericardial rupture without vascular or cardiac involvement accounts for only 17% of reported cases. We describe a rare case of right-sided pericardial rupture following blunt chest trauma, an unusual presentation since most pericardial tears occur on the left side. A 23-year-old woman involved in a motor vehicle accident sustained multiple injuries, including right hemothorax, bilateral pulmonary contusions, left-sided rib fractures, and a humerus fracture. Although preoperative computed tomography showed no diagnostic findings, persistent bleeding from the right chest tube prompted exploratory thoracotomy. Intraoperative evaluation revealed a 10-cm right pericardial tear extending from the superior vena cava to the inferior vena cava, with no associated cardiac injury. Surgical management included primary closure of the pericardial tear and repair of adjacent pleural injuries. Postoperatively, the patient developed right diaphragmatic palsy due to phrenic nerve involvement. Pericardial rupture is challenging to diagnose, but in this case, persistent hemothorax facilitated early recognition and intervention. Prompt identification allowed timely surgical repair, likely preventing life-threatening complications such as cardiac herniation. This case highlights the importance of considering pericardial rupture in patients with blunt chest trauma presenting with unexplained clinical findings and underscores the value of early surgical management.
Proximal hamstring complex tears are uncommon injuries in gymnastics. This case report describes a rare instance of a 17-year-old female gymnast who sustained a complete avulsion of the proximal hamstring complex during exercise. The injury was diagnosed clinically and later confirmed by magnetic resonance imaging as a proximal hamstring tear, prompting surgical repair with suture anchors. The patient underwent a structured rehabilitation program with progressive milestones in weight-bearing, mobility, and strength training. By postoperative 26 weeks, she had regained functional strength and returned to competitive activity. This case highlights the importance of early diagnosis, timely surgical intervention, and a carefully managed rehabilitation protocol in achieving successful outcomes for young gymnasts. It also underscores the need for greater awareness and documentation of proximal hamstring complex tears in gymnastics, where such cases remain underreported. This report demonstrates the potential for full recovery and return to sport with appropriate treatment and rehabilitation, providing valuable insight into the management of this rare injury.
Open intrathoracic visceral injuries are rare in electrical burns. We report the case of a 65-year-old man who sustained a high-voltage electrical burn through direct cable exposure. He arrived at the burn intensive care unit with respiratory distress secondary to an open wound on the right side of the chest wall measuring approximately 4×2 cm, with a calculated total body surface area of 2%. An immediate thoracostomy tube was placed to treat the open pneumothorax. Pneumopericardium, pneumomediastinum, and pleural infection developed later as delayed complications despite initial stabilization. After 42 days of hospitalization, the patient was discharged. This case highlights the rare occurrence of thoracic complications following electrical injury and underscores the importance of multidisciplinary, phased therapy in the management of severe electrical damage.
