SURGERY FOR THORACOABDOMINAL INJURY CAUSED BY GUNSHOT 〜 WHAT SHOULD BE DONE TO SAVE THE LIFE OF A TORSO GUNSHOT WOUND PATIENT?

Abstract

　　Torso gunshot wounds require immediate transport to medical facilities that provide early surgical hemostasis. Timeliness is paramount for early care. As the adage ‘the golden 10 minutes’ implies, failure to access the operating room within this timeframe increases the risk of death. In cases of imminent cardiac arrest, resuscitative thoracotomy should be performed. Surgical intervention is recommended for patients with unstable circulation. Injuries in the thoracoabdominal transition zone necessitate consideration of both thoracic and abdominal trauma. Maintaining a clear field of vision is imperative for achieving hemostasis in injuries involving the superior mediastinum and subclavian artery. Surgeons should alter their approach in cases where securing the operative field is challenging. Gunshot wounds may result in non-linear injuries. In some cases, balloon tamponade may be effective. Management of injuries to the major vascular system should prioritize central control without causing further injury, adhering to the principle of proximal control. The key to the successful surgical management of torso gunshot wounds is the speed of intervention. A hospital trauma system should be established to facilitate early hemostasis.