2016 Volume 30 Issue 4 Pages 454-457
We report a case of severe multiple blunt trauma in a 51-year-old male who had fallen from a height. After the arrival of the air ambulance, he was diagnosed with a massive left hemothorax and an unstable pelvic fracture. At the scene, he underwent tracheal intubation and left thoracostomy. Upon arrival at hospital, he was in a state of cardiopulmonary arrest caused by hemorrhagic shock due to the massive left hemothorax. Therefore, resuscitative thoracotomy was performed for the massive left hemothorax, and immediate pulmonary hilum clamping was conducted as a damage control measure against active bleeding from a deep pulmonary laceration. After aortic occlusion had been performed to achieve primary hemostasis, the patient was transported to a hybrid operating room, and left lower lobectomy was performed along with gauze packing. After the lobectomy, transcatheter arterial embolization and external fixation were carried out for the unstable pelvic fracture. Thus, this case shows that resuscitative thoracotomy and pulmonary hilum clamping are radical and applicable to a limited subset of cases of severe hemorrhagic shock caused by blunt trauma-induced deep pulmonary lacerations.
