We investigated whether early intervention by a doctor-helicopter system influenced the outcome of multiple trauma patients. We divided multiple trauma patients who required emergency surgery for severe traumatic brain injury into two groups, one brought to hospital by doctor-helicopter (DH group) and the other by ambulance (AC group). Comparison between these groups revealed the time from perception of trauma to primary treatment to be significantly shorter for the DH group, at 16±7 minutes, than for the AC group, at 30±11 minutes. The lactate level on arrival at hospital was significantly higher in the AC group, at 3.6±1.3 mmol/L, than in the DH group, at 2.3±1.3 mmol/L. The patients in shock on arrival at hospital numbered 0 for the DH group (0%) and 3 (30%) for the AC group. GOS was good in 5 patients (45%) in the DH group and 2 patients (20%) in the AC group, showing that more patients in the DH group tended to have good GOS. The life-saving rate was 40% for the AC group and was higher, at 82%, for the DH group. These results suggest the possibility that intervention by doctor-helicopter would prevent circulatory failure and improve the life-saving rate.
We report a case of abdominal compartment syndrome (ACS) caused by a lumbar vertebral fracture-induced lumbar artery injury in a patient with diffuse idiopathic skeletal hyperostosis (DISH). A 77-year-old man was transferred to our institution for suspected renal injury after falling over. Contrast-enhanced CT revealed a transverse fracture of the lumbar spine with DISH and massive retroperitoneal hemorrhage with extravasation of the contrast medium. A hyperostotic lesion due to DISH was highly suspected to have been a direct cause of the lumbar artery injury. Transcatheter arterial embolization (TAE) was successfully performed, but ACS developed immediately after the procedure. Decompressive laparotomy and open abdomen management with the combined technique of silo and vacuum packing closure was carried out for the next 7 days. The patient recovered without any complications and was discharged on day 72 following operative internal fixation of the fractured lumbar spine.
A 47-year-old man who had cirrhosis exhibited bruising on his left abdominal wall. Upon arrival, his systolic blood pressure was 88 mmHg and pulse was 96 beats/min. CT showed laceration of the upper pole of the spleen and extravasation in the delayed phase. After he underwent angiographic embolization of the splenic artery, his systolic blood pressure rose to 100 mmHg. During conservative management in the ICU, his blood pressure dropped again. Therefore, he underwent emergency laparotomy. Ongoing bleeding from the splenic laceration was found and he underwent splenectomy. His spleen was AAST grade II . Twenty-two hours after his arrival at hospital, the patient died. We were not able to stop the bleeding because of the cirrhosis.
A 6-year-old boy who fell off his bicycle and sustained contusional injury of the upper abdomen caused by the impact of the bicycle handlebar was brought to our hospital. On arrival, he was alert, the blood pressure was 104/69 mmHg, and the heart rate was 87/min. Dynamic CT revealed crush injury of the right hepatic lobe with hepatic artery pseudoaneurysm and bleeding in the abdominal cavity. Grade IIIa liver trauma (Classification of Organ Injury, JAST 2008) was diagnosed, and transcatheter arterial embolization (TAE) was planned because the cardiovascular status was stable. The patient could be maintained in the resting position without sedative medication. As extravasation from the replaced right hepatic artery A8 was noted, intra-arterial embolization was performed. The patient had an uneventful postoperative course and was discharged on day 14. Liver injury caused by impact of a bicycle handlebar in a child is uncommon, but can result even from a relatively small external linear force. Such impact may give rise to the formation of a pseudoaneurysm, despite a stable circulatory status. The present results indicate that TAE is an effective treatment modality in such cases.
Gallbladder injury due to blunt abdominal injury is very rare, comprising approximately 2% of abdominal injuries because of significant anatomical protection. We report here our experience with the successful treatment of gallbladder injury upon blunt trauma after drinking. A 69-year-old female was taken to our hospital for a car accident after drinking. There was localized tenderness around the hypochondriac area. Enhanced computed tomography revealed a hemorrhage in the gallbladder and fluid collection around the liver. An emergency operation was performed. Laparotomy showed laceration of the gallbladder involving the body. There was no evidence of associated intra-abdominal injuries. Cholecystectomy was performed. The patient was sent home on the 7th postoperative day.
Emergency medical care is very important in cases of open fracture with hemorrhagic shock, and we are forced to make a decision about amputation for hemostasis in some cases. However, we must perform osteotomy for such amputation, so there are problems such as a long operation time and the promotion of bleeding. In such cases, we conclude that disarticulation is effective. It is expected to be associated with a short surgery time and little bleeding. Here, we describe the rescue of 3 cases of open fracture of a lower limb that could not be rebuilt with hemorrhagic shock, by performing amputation stump plasty as a curative operation after damage control surgery (DCS) and intensive care. We could perform DCS more rapidly than a curative operation in all cases.
Symptoms of blunt cardiac injury are often nonspecific, so electrocardiography (ECG) abnormalities may help in the diagnosis. We report a case of atrial fibrillation (AF) from cardiac injury in a traffic accident in which the patient recovered without pharmacotherapeutics. The patient was a 22-year-old man who was wearing a seatbelt when he sustained an injury by running into a truck. There were no subjective symptoms or physical findings on his chest upon admission to our hospital. His initial ECG showed AF without elevation of cardiac troponin I (cTnI) and no echocardiography abnormalities. However, cardiac troponin T (cTnT) was elevated 7 hours after the trauma. Two days later, he was discharged because of restoration of normal sinus rhythm and a normal cTnT level. This is a rare case because there are few reports of AF caused by cardiac injury that did not require drug therapy.
This report presents a case of adrenal injury with active bleeding that was treated using gauze packing. A 21-year-old man who had been involved in a motor vehicle accident was transferred to our hospital. Abdominal contrast-enhanced computed tomography revealed lung injuries, liver injuries, right renal injury, and adrenal injury with active bleeding ; therefore, an emergency laparotomy was performed. The retroperitoneal pressure suppressed the bleeding due to the adrenal injury. However, dissection into the retroperitoneum to repair the renal injury resulted in loss of the compressive effect of the adjacent structures ; therefore, the adrenal injury had to be repaired along with the hepatic injury. Gauze packing was effective, and aortography did not reveal any extravasation. The findings of this case, suggest that gauze packing should be considered for treating adrenal injury with active bleeding, especially in cases in which open surgery is performed before angiography.