A CASE OF SEVERE MULTIPLE TRAUMA TREATED BY PRE-HOSPITAL RESUSCITATIVE THORACOTOMY

Abstract

　　A 63-year-old Chinese woman fell from the road to the promenade while driving. She was transported by helicopter emergency medical service from the scene. She was in an unstable status with flail chest and intraperitoneal hemorrhage, and the medical staff performed pre-hospital resuscitative thoracotomy. Electrocardiography demonstrated PEA during transportation and we urgently performed splenectomy as abbreviated surgery at the emergency department. She had brain contusion, thoracic injury (The 2008 classification of organ injury by The Japanese Association for The Surgery of Trauma IIIb), left lung injury (Ib), splenic injury (IIIb), pelvic fracture (Ia), seventh cervical transverse process fracture, and right humerus fracture. We performed the planned operation and rib fracture fixation for flail chest on day 4. Postoperative complications, such as surgical site infection and pancreatic fistula, were observed, but both were treated by conservative therapy. She was discharged on day 97. If severe hemorrhagic shock is noted at the scene, prehospital resuscitative thoracotomy should be considered.