We performed a multicenter prospective observational study on the importance of cold sweat as a skin-related finding for the early recognition of shock in trauma patients. Patients with shock were defined as those who required interventions to resolve hemorrhagic or obstructive shock. Cold sweat was evaluated at 4 sites on both the left and right sides by 2 physicians. Cold sweat was defined present when observed at a minimum of １ site by both physicians. Shock was present in 54 (13%) and cold sweat in 36 (9%) of 411 trauma patients. The sensitivity, specificity, and positive and negative predictive values of cold sweat for shock were 35, 95, 53, and 91%, respectively. Patients with cold sweat in shock showed a significantly higher incidence of tachycardia, lower base excess, and higher lactic acid level compared with patients without cold sweat. The sensitivity of cold sweat for shock was not high, but its specificity was high. Therefore, for the early recognition of shock, it is important to actively determine the presence or absence of cold sweat, and combine this with other findings.
Orbital sub-periosteal hematomas result from facial trauma, which is the major cause for hyperemia, and may sometimes occur spontaneously. Symptoms include heterotropia, exophthalmos, and diplopia, which are caused by disordered eye movement. A 79-year-old woman who had been choked by a belt was diagnosed with orbital sub-periosteal hematoma. Although she had altered mentation due to neck constriction on arrival, she was alert the next day. Eye movement or any other disorders were not observed, and she was discharged. These findings suggested that neck constriction may cause orbital sub-periosteal hematomas. Conservative treatment may be sufficient when minimal symptoms are observed in patients with orbital sub-periosteal hematomas.
Transcatheter arterial embolization is widely performed in hemodynamically stable patients with blunt liver injury, wherein biloma is one of its major complications. We present a case of hepatic compartment syndrome (HCS), in whom intrahepatic pressure had built up due to the accumulation of bile during the sub-acute phase after blunt trauma. Diagnosis was made with computed tomography (CT) and observation of the clinical course. HCS due to biloma is rare ; nevertheless, trauma physicians should take care to remember this complication when treating blunt liver injury patients, and that it is important to promptly relieve the intraparenchymal pressure.
A 30-year-old man was impaled by a reinforced steel rod after slipping down a slope and onto the rod, which had been leaning against the slope. The rod entered his body through the right scrotum and continued upwards for approximately 50 cm. Computed tomography showed the entire internal length of the impaled rod, from the right scrotum to the abdominal cavity at the level of the right costal arch. Emergency laparotomy revealed a 2-cm-long diaphragmatic tear, superior and dorsal to the tip of the rod, which was then repaired. There was no injuries to any of the organs. In the time between the injury and surgery, the tip of the rod had migrated from the thorax to the abdominal cavity, probably due to repositioning post injury. In cases of impalement, it is important to consider that the impaled object may move within the body when the position of the patient is changed.
A 19-year old female was involved in a car accident and was diagnosed with multiple rib fractures, bilateral pulmonary contusions and pneumothorax, liver injury, and iliac open fracture. Because a computed tomography scan showed that the distance between the left ninth rib fracture end and the descending aorta was 12 mm, we initially planned conservative management for her injuries. However, on the fifth post-trauma day, CT showed bone particles migrating to the thoracic aorta (4 mm), and thoracoscopic surgery to excise the rib fragments was performed. Although traumatic rupture of the thoracic aorta is rare, in the present case, we were able to prevent descending aorta injury through prophylactic resection of the fractured rib ends.