Prehospital recognition of life-threating thoracic trauma

Abstract

Introduction: Severe thoracic trauma is a potentially lifethreatening injury, leading to immediate impairment of cardiorespiratory functions or bleeding; but also consequential fatal infections, damage of: heart, large blood vessels, mediastinal organs or pleura with pneumothorax/hematothorax. Objective: To present a case of penetrating chest injuries with forks, caused by traffic. Methodology: Case report from medical documentation. Case report: The EMS team was called for a car accident including vehicle and a tractor. At the passenger seat of the car, a female person was found stabbed with a pitchfork through the torso and fixed to the seat. Firefighters cut a part of the metal forks, while medics stabilized foreign body and made emporary hemostasis. The entrance and exit wounds were verified. Vitals were: TA: 130/60mmHg, heart rate 100/min, SaO2 90%. The peripheral venous line was opened and O2 10L/min was applied through an oxygen mask. The patient was transported in a sitting position, with medical manual stabilization, to the ER. The surgeon was immediately consulted and the patient, due to vital indications, was urgently admitted to the operating room. In the abdomen, 8 cm laceration of the III segment of the liver, cleft omentum and deserosion of the small curve of the stomach were verified. A foreign body passed between the aorta and the esophagus, without injuring them. Conclusion: Thanks to the prompt EMS reaction and the proper pre-hospital care, as well as early inpatient surgical treatment, the patient's outcome was good.