We developed an artificial blood that has potent hemostatic and oxygen carrying effects, and requires neither blood typing nor crossmatch testing. Our artificial blood consisting of platelet substitutes [H12- (ADP) -liposomes] and red blood cell substitutes [hemoglobin vesicles, a cellular-type hemoglobin-based oxygen carrier] can be stored for a long period at room temperature without shaking. H12- (ADP) -liposomes bear synthetic HHLGGAKQAGDV (H12) peptides corresponding to the carboxyl terminal of the fibrinogen γ-chain on their surface and encapsulate the physiological platelet agonist adenosine diphosphate (ADP). They can accumulate at bleeding sites and promote platelet thrombi even under thrombocytopenic coagulopathy. In acute thrombocytopenic rabbits with noncompressible penetrating liver injury, combination therapy with intravenous infusions of H12- (ADP) -liposomes followed by hemoglobin vesicles enabled the rescue from severe massive hemorrhage with coagulopathy due to the potent hemostatic and oxygen carrying effects. Our artificial blood may be useful for damage control resuscitation of trauma-induced massive hemorrhage, especially pre-hospital resuscitation.

　　A 46-year-old man was hit by a motorcycle while walking on a pedestrian crossing. On admission, he was diagnosed with polytrauma, including left flail chest, multiple bilateral rib fractures, bilateral hemopneumothorax, and severe limb injury. Ventilation support was provided through bilateral chest tube insertion and tracheal intubation. Left rib fixation was performed on day 7 and ventilator support was withdrawn on day 8 of hospitalization. Chest radiography performed on day 9 revealed left diaphragmatic injury and diaphragm repair was performed using an open-abdomen approach on day 10. Traumatic diaphragmatic injury is difficult to diagnose during positive pressure ventilation. In cases of severe chest trauma during positive pressure ventilation, careful examination using roentgenography or computed tomography is required in consideration of the complications associated with traumatic diaphragmatic injury ; if traumatic diaphragmatic injury is difficult to confirm during thoracoabdominal surgery, thoracoscopy should be used.

　　Vascular injury associated with proximal humeral fractures is rarely reported and no standard treatment has been established. The VIABAHN^® endoprosthesis may be used to repair traumatic or iatrogenic vascular injuries. An 87-year-old man presented with impaired mobility. He sustained a proximal left humeral fracture three months before. Anemia was present (Hb 6.0 g/dL) and contrast-enhanced computed tomography to identify the source of bleeding led to the diagnosis of pseudoaneurysm of the left axillary artery. As the patient had a pacemaker implanted in the left thoracic region, endovascular therapy using a VIABAHN^® was selected in order to avoid surgery. A retrograde approach via the left radial artery was employed and the pseudoaneurysm disappeared as a result of stent compression. Postoperatively, there were no endoleaks or migration and the patient was transferred to another healthcare provider. VIABAHN^® may provide an effective minimally invasive therapeutic option for the treatment of axillary artery injury, even in cases where surgical repair is difficult.

　　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.

　　The patient was a 21-year-old male who collided with a passenger car while riding his motorcycle and was transported to our emergency center. On admission, physical examination revealed bruising on the penis and symptoms of persistent erection. Contrast-enhanced computed tomography (CT) demonstrated contrast leakage from the internal pudendal artery and cavernous sinus fistula, leading to a diagnosis of high-flow priapism. Emergency angiography with selective embolization of the internal pudendal artery was performed. Immediately after the procedure, the contrast leakage, fistula and erectile symptoms disappeared. Two months after the injury, the patient was able to have an erection with no functional impairment. We report a case of traumatic high-flow priapism, which is relatively rare, that was diagnosed by contrast-enhanced CT on the day of injury and cured by endovascular treatment.