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Purpose Unstable pelvic fracture with bleeding can be fatal, with a mortality rate of up to 40%. Therefore, early detection and treatment are important in unstable pelvic trauma. We investigated the early predictive factors for possible embolization in patients with hemodynamically unstable pelvic trauma. Methods From January 2011 to December 2013, 46 patients with shock arrived at a single hospital within 24 hours after injury. Of them, 44 patients underwent CT scan after initial resuscitation, except for 2 who were dead on arrival. Nine patients with other organ injuries were excluded. Seventeen patients underwent embolization. A single radiologist measured the width (longest length in axial view) and length (longest length in coronal view) of pelvic hematoma on CT scans. Demographic, clinical, and radiological data were reviewed retrospectively. Results Among 35 patients with hemodynamically unstable pelvic fracture, 22 (62.9%) were men. Width (P = 0.002) and length (P = 0.006) of hematoma on CT scans were significantly different between the embolization and nonembolization groups. The predictors of embolization were width of pelvic hematoma (odds ratio [OR], 1.07; P = 0.028) and female sex (OR, 10.83; P = 0.031). The cutoff value was 3.35 cm. More embolization was performed (OR, 12.00; P = 0.003) and higher mortality was observed in patients with hematoma width >3.35 cm (OR, 4.96; P = 0.048). Conclusion Patients with hemodynamically unstable pelvic trauma have a high mortality rate. CT is useful for the initial identification of the need for embolization among these patients. The width of pelvic hematoma can predict possible embolization in patients with unstable pelvic trauma.

Posterior reversible encephalopathy syndrome (PRES) is a transient condition characterized by altered mental status, seizure, headache, and visual disturbance with typical neuro-imaging findings in the bilateral parieto-occipital regions. Clinicians should be aware of this syndrome because delayed diagnosis and treatment result in irreversible neurologic deficits. We present the case of a 77-year-old male diagnosed with PRES in the setting of postoperative critical illness caused by small-bowel strangulation.

The role of central venous catheters managers and effectiveness of reduction CLABSI in surgical intensive care unit Sungdae Shin, Yoon joong Jung, Jun ju Lee, Se ra Kim, Soon heang Lee, Hyo keun No, Min ae Keum, Suk-kyung Hong ASAN Medical Center, Republic of Korea Background/Purpose: The use of central venous catheters (CVCs) is an integral part of critical care for the not only injection of medication and parenteral nutrition but also the access of hemodynamic monitoring and hemodialysis. However, CVC-related infections are occurring in 5% to 26% of patients. These serious infectious complications are associated with increased morbidity, mortality, and health care costs. This study is to analyze the effectiveness of CVC managers for the prevention of central line– associated bloodstream infection (CLABSI) between each 9 months in surgical intensive care unit (SICU). Methods:With a retrospective study, the prevalence of CLABSI was compared between the preintervention period (PRE, January 2013 to September 2013) and the postintervention period (POST, October 2013 to June 2014) each 9 months in SICU. CVC manager performed daily rounding to check the condition of CVCs and if required dressing following CDC guidelines. Managers reported to the physicians the status of CVCs as soon as inflammation signs are detected. Results: A total of 242 patients from pre-intervention periods and 196 patients from postintervention periods were analyzed except patients with early discharge within 48 hours and without central line. There is no significant difference between 2 groups related to age, gender, reason for ICU admission, ICU admission route, APACHE II score, ventilator day, and length of stay in ICU. Incidence rate ratio (IRR) was reduced 2.5 in the postintervention (1.46/1000 device days) compared to preintervention (3.67/1000 device days). Conclusions: Because patients in SICU have inserted central line with operation, it is difficult to decrease the use rate. However, it is assumed that organized and constant interventions by CVC managers can effectively decline CLABSI.

Purpose: Inferior vena cava (IVC) filter is commonly practiced to prevent pulmonary embolism during endovascular therapy of deep vein thrombosis (EndoDVT). When the thrombus is trapped inside the filter during intervention, its removal is quite challenging. The purpose of this study is to determine retrieval rates of IVC filter after EndoDVT and its characteristics. Methods: Patients who underwent EndoDVT in Inha Unversity Hospital from June 2004 to May 2009 were reviewed retrospectively. Retrievable IVC filter was inserted before EndoDVT. EndoDVT was done by catheter directed thrombolysis or pharmacomechanical thrombectomy using urokinase. IVC filter retrieval was decided according to computed tomography after 2 weeks. Results: 126 patients were treated with EndoDVT. Optease (n=101) and Tulip (n=25) IVC filters were inserted. IVC filters were retrieved in 42.9% (54/126). There was no IVC filter related complication during its insertion and removal. IVC filter was not retrieved in 72 patients. Reasons for its failure include residual thrombosis in IVC filter (n=28), high risk for recurrent DVT (n=34), massive pulmonary embolism (n=8), and death (n=2). Residual thrombus inside IVC filter disappeared in 5 patients during 6-month follow up. Conclusion: IVC filters retrieval rate after EndoDVT was 42.9%. This can be improved by thorough patient follow up and extended retrievability.