The case was a 9-year-old boy. He fell while cycling and was transported to a nearby hospital. In this previous hospital, liver damage III b (Japan Trauma Society liver damage classification) was found by abdominal enhanced computed tomography (CT). His systolic blood pressure decreased to 60mmHg in the ambulance during transportation to our emergency and critical care center. Because of this hemodynamic instability, we decided on emergency open surgery and damage control surgery. We undertook TAE to stop the continuous bleeding that had lasted for 2 postoperative days. We closed the abdominal wall on the 6th postoperative day and discharged him on the 17th postoperative day. We thought that precise inspection and rapid decision are important when abdominal organ damage is predicted in children with upper abdominal pain due to bicycle handle trauma.
We encountered 2 patients with multiple trauma in whom control of intracranial pressure (ICP) was effective only through ventricular drainage. In these two cases, there was multiple trauma with severe head injury, and the injury severity scores (ISS) were high. In these patients, an ICP sensor was initially inserted and ventricular drainage was performed when ICP reached a high value. ICP control was favorable, and there were no complications. Ventricular drainage accurately reduces ICP, and can be noninvasively performed in a short time. Therefore, this procedure is advantageous for patients with multiple trauma. Ventricular drainage may be a therapeutic strategy that should be positively considered in multiple trauma patients with severe head injury.
A 25-year-old male who had been diagnosed with schizophrenia amputated his tongue by himself with scissors. His tongue was amputated at the proglossis and the posterior part of the tongue had descended to the pharynx at arrival. Active bleeding was observed from the stump of the tongue. The bleeding was effectively controlled by grasping the stump of his tongue with Satinsky's blood vessel clamp, and this technique also enabled the tongue's stump to be lifted up into the oral cavity. Stump plasty operation was performed. He was transferred to another hospital on the 8th day and could swallow, manducate and talk. There is no adequate tool for apocoptic tongue. Emergency physicians are sometimes required to modify tools in the emergency room. Satinsky's clamp was effectively used for hemostasis and grasping the tongue without causing other injury.
We attended a trauma surgery workshop using soft human cadavers in Chulalongkorn University, Thailand. A special solution developed at Chulalongkorn University enabled the preserved cadavers to be kept soft and fresh. The cadavers were so well preserved that the texture of the organs was exactly the same as that of live tissue. This workshop focused on major vascular trauma, and participants included trauma residents and trauma surgeons from all over Thailand. Professor Kenneth Mattox was invited as an adviser for this entire course. The course consisted of a half-day workshop with ４ lectures, at which Dr. Mattox made comments and suggestions to the attendees, followed by a hands-on workshop. One cadaver was supplied to groups of 5 or 6 participants and one instructor was assigned to work with them. Because of their technology, a variety of trauma surgical procedures for injuries of the neck and torso were achieved, with the same feel as actual surgery on live patients. Although there are some problems, including cost, human resources, and ethical issues, this cadaver model is considered one of the most useful options for off-the-job training on trauma surgery.