[Purpose] The Japan Prehospital Trauma Evaluation and Care™ (JPTEC™) program serves as a guideline for prehospital trauma evaluation and care for health care workers, including paramedics, doctors and nurses, in Japan. The JPTEC™ first responder (FR) course, which was designed in 2016, is a training course for non-health care providers. In this study, we focused on medical care for trauma and regularly held the JPTEC™ FR course, which was modified for health care workers, during the clinical clerkship of medical students. The usefulness of the JPTEC™ FR course in trauma education for medical students was assessed using a questionnaire. [Methods] We administered a questionnaire for the self-evaluation of trauma response and care after attending the JPTEC™ FR course. [Results] Many medical students evaluated the JPTEC™ FR course favorably and were highly satisfied with the instruction. In addition, the students were confident in the basic procedure for trauma response, and considered themselves able to correctly perform situational, physiological and anatomical assessments. [Conclusion] The JPTEC™ FR course modified for medical students is a highly useful tool for trauma education.
We report the successful repair of a diaphragmatic injury caused by a chest stab employing a transthoracic surgical approach with thoracoscopy. A 60-year-old man was stabbed in the left neck and left chest while sleeping. He was taken to a nearby hospital, and diagnosed with left diaphragmatic injury by CT and transferred to our hospital for further examination and treatment. We repaired the diaphragm via a transthoracic approach because physical findings and CT demonstrated no abdominal organ injury. He recovered smoothly and was discharged on the 14th hospital day. Diaphragmatic injuries due to chest-penetrating trauma can be repaired by a transthoracic approach if abdominal organ injury is absent. A chest approach should be considered from the viewpoint of ease of operation and reduction of postoperative complications.
Non-operative management (NOM) is indicated as a treatment strategy for liver injury with stable vital signs and no active bleeding on enhanced CT. We report a pediatric case in which the hemodynamics became unstable the day after admission when NOM was initiated due to rupture of subcapsular hematoma. Transcatheter arterial embolization (TAE) was required for a pseudoaneurysm in the peripheral hepatic arteries. CT on the 9th day after injury revealed a pseudoaneurysm at a different site and secondary TAE was performed. Pediatric type I liver injury may require angiographic evaluation even if extravasation of contrast media is not observed on CT.
A 58-year-old man was injured by a package falling on his chest. After clinical examination, we diagnosed him with flail chest, which was mainly caused by sternal fractures, multiple rib fractures, and left hemopneumothorax. On the day after admission, we performed internal pneumatic stabilization because of the deteriorating respiratory condition ; however, the patient exhibited little improvement. We then surgically implanted a locking plate to stabilize the sternal fracture. On the first postoperative day, we weaned the patient off the ventilator and he was subsequently discharged.
Most sternal fractures are managed conservatively and surgery is rarely necessary. Our patient demonstrated good outcomes after plate fixation. In cases in which sternal fractures are associated with respiratory failure or severe dislocation, we recommend plate fixation to improve the respiratory condition, reduce pain, and stabilize the fracture. Our report will be useful for physicians and surgeons who routinely manage patients with chest trauma.