Pub Date : 2021-11-30DOI: 10.24184/tip.2021.6.1.28
Hyung Il Kim
Hemorrhagic shock can develop due to severe bleeding, such as after major trauma, postpartum or gastrointestinal bleeding. At least two peripheral intravenous routes with large-bore catheters are recommended to reverse hemorrhagic shock, and such functional intravenous routes are essential for the proper management of other concurrent diseases as well. Conditions during helicopter transportation are different from those seen in-hospital, and the primary concerns are to maintain aseptic conditions, protect patient’s privacy, and prevent infection risk, especially during pandemics, such as the ongoing COVID-19. Herein, I describe two recent experiences of improper management during helicopter transport due to intravenous line malfunction. Subsequently, based on my experience, I suggest the use of multiple intravenous routes or preemptive central catheterization in patients requiring helicopter transportation.
{"title":"The need for multiple vascular access or preemptive central venous catheterization in patients requiring planned interhospital helicopter transport: a flight doctor’s suggestion","authors":"Hyung Il Kim","doi":"10.24184/tip.2021.6.1.28","DOIUrl":"https://doi.org/10.24184/tip.2021.6.1.28","url":null,"abstract":"Hemorrhagic shock can develop due to severe bleeding, such as after major trauma, postpartum or gastrointestinal bleeding. At least two peripheral intravenous routes with large-bore catheters are recommended to reverse hemorrhagic shock, and such functional intravenous routes are essential for the proper management of other concurrent diseases as well. Conditions during helicopter transportation are different from those seen in-hospital, and the primary concerns are to maintain aseptic conditions, protect patient’s privacy, and prevent infection risk, especially during pandemics, such as the ongoing COVID-19. Herein, I describe two recent experiences of improper management during helicopter transport due to intravenous line malfunction. Subsequently, based on my experience, I suggest the use of multiple intravenous routes or preemptive central catheterization in patients requiring helicopter transportation.","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122386021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-30DOI: 10.24184/tip.2021.6.1.16
KwangJin Lee, P. Y. Jung
Acute appendicitis is a relatively common disease, but it is rarely caused by trauma. There are some reports on appendicitis caused by blunt abdominal trauma, but the pathophysiology is still uncertain. In this report, we presented a case of a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident.
{"title":"Incidental appendicitis in a blunt trauma patient: a case report","authors":"KwangJin Lee, P. Y. Jung","doi":"10.24184/tip.2021.6.1.16","DOIUrl":"https://doi.org/10.24184/tip.2021.6.1.16","url":null,"abstract":"Acute appendicitis is a relatively common disease, but it is rarely caused by trauma. There are some reports on appendicitis caused by blunt abdominal trauma, but the pathophysiology is still uncertain. In this report, we presented a case of a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident.","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114790960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-30DOI: 10.24184/tip.2021.6.1.32
Yoonjung Heo, D. H. Kim
Central venous catheters (CVCs) are commonly used in patients with trauma. The placement and removal of the CVCs can result in various complications regardless of the skill of the professionals. Herein, two cases of rare complications are presented— an inadvertent subclavian artery catheterization and a cerebral air embolism after a CVC removal. Moreover, practical solutions for each complication are provided in detail.
{"title":"Unusual complications of the central venous catheterization in trauma patients","authors":"Yoonjung Heo, D. H. Kim","doi":"10.24184/tip.2021.6.1.32","DOIUrl":"https://doi.org/10.24184/tip.2021.6.1.32","url":null,"abstract":"Central venous catheters (CVCs) are commonly used in patients with trauma. The placement and removal of the CVCs can result in various complications regardless of the skill of the professionals. Herein, two cases of rare complications are presented— an inadvertent subclavian artery catheterization and a cerebral air embolism after a CVC removal. Moreover, practical solutions for each complication are provided in detail.","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132948318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-31DOI: 10.24184/tip.2019.4.1.10
Seong Chan Gong, P. Y. Jung
A 70-year-old man came to our facility after a car accident. The vital signs were unstable; blood pressure could not be recorded at the time of arrival. Immediately after arrival, cardiac arrest occurred twice, and resuscitation was successful. In the emergency room, he underwent brief sonographic examination, and a massive fluid collection was observed in the splenorenal recess. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was also performed with blind puncture technique during the resuscitation. The balloon was inflated with 25 mL of normal saline, but there was no sense of resistance, which is considered unusual. Placement of the catheter tip was checked with bedside ultrasonography but was not clearly confirmed because of the massive fluid collection. In general, catheter tip placement is confirmed with radiography, fluoroscopy, or ultrasonography (1), but the serious emergency situation precluded these assessments. The patient’s blood pressure recovered to 80/50 mm Hg, and he was moved to the operating room immediately. During the operation, vascular rupture from aortic bifurcation to the left common iliac artery was confirmed (Fig. 1). The REBOA catheter was found to be misplaced: It had been inserted correctly via the femoral artery, but it exited through the ruptured pore of the iliac artery (Fig. 2). We inserted the catheter back into the aorta urgently and then compressed the injured site to control bleeding; however, cardiac arrest continued. The abdomen was closed, the patient was moved to the intensive care unit, and then he was pronounced dead. Brief Image in Trauma eISSN: 2508-8033 pISSN: 2508-5298
一位70岁的老人在车祸后来到我们这里。生命体征不稳定;到达时无法记录血压。到达后立即发生两次心脏骤停，复苏成功。在急诊室，他接受了简短的超声检查，在脾肾隐窝发现大量积液。复苏过程中采用盲穿刺技术行复苏性血管内球囊闭塞术(REBOA)。用25毫升生理盐水对球囊进行充气，但没有感觉到阻力，这是不寻常的。通过床边超声检查导管尖端的位置，但由于大量液体收集而无法明确确认。一般来说，导管尖端的放置是通过x线摄影、透视或超声检查来确认的(1)，但严重的紧急情况使这些评估无法进行。患者血压恢复到80/50 mm Hg，立即转移至手术室。术中证实主动脉分叉至左髂总动脉血管破裂(图1)。REBOA导管错位:经股动脉正确插入，但经髂动脉破裂孔排出(图2)。我们紧急将导管插入主动脉，并压迫损伤部位止血;然而，心脏骤停仍在继续。腹部被封闭，病人被转移到重症监护室，然后他被宣布死亡。创伤简图eISSN: 2508-8033 pISSN: 2508-5298
{"title":"Inappropriate Resuscitative endovascular balloon occlusion of the aorta (REBOA) Catheter Placement in Patient With Unexpected Left Common Iliac Artery Rupture","authors":"Seong Chan Gong, P. Y. Jung","doi":"10.24184/tip.2019.4.1.10","DOIUrl":"https://doi.org/10.24184/tip.2019.4.1.10","url":null,"abstract":"A 70-year-old man came to our facility after a car accident. The vital signs were unstable; blood pressure could not be recorded at the time of arrival. Immediately after arrival, cardiac arrest occurred twice, and resuscitation was successful. In the emergency room, he underwent brief sonographic examination, and a massive fluid collection was observed in the splenorenal recess. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was also performed with blind puncture technique during the resuscitation. The balloon was inflated with 25 mL of normal saline, but there was no sense of resistance, which is considered unusual. Placement of the catheter tip was checked with bedside ultrasonography but was not clearly confirmed because of the massive fluid collection. In general, catheter tip placement is confirmed with radiography, fluoroscopy, or ultrasonography (1), but the serious emergency situation precluded these assessments. The patient’s blood pressure recovered to 80/50 mm Hg, and he was moved to the operating room immediately. During the operation, vascular rupture from aortic bifurcation to the left common iliac artery was confirmed (Fig. 1). The REBOA catheter was found to be misplaced: It had been inserted correctly via the femoral artery, but it exited through the ruptured pore of the iliac artery (Fig. 2). We inserted the catheter back into the aorta urgently and then compressed the injured site to control bleeding; however, cardiac arrest continued. The abdomen was closed, the patient was moved to the intensive care unit, and then he was pronounced dead. Brief Image in Trauma eISSN: 2508-8033 pISSN: 2508-5298","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125997159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-31DOI: 10.24184/tip.2019.4.1.12
J. Ko, P. Y. Jung
A 63-year-old woman was in a car accident; she had been sitting in the passenger seat. In the emergency room, the patient’s blood pressure was 82/46 mm Hg, the pulse rate was 84 beats/min, and her level of consciousness was normal. The lower abdomen was bruised with a seat belt sign (Fig. 1.). The extended focused assessment sonography in trauma showed a moderate to severe intra-abdominal fluid collection in Morison's pouch and in perivesical sites. The hemoglobin level was 8.8 g/dL, and the lactate level was 1.82 mmol/L. No further imaging tests were performed, and exploratory surgery proceeded immediately. The operative findings were perforations of the transverse colon and transverse mesocolon. Repair with primary sutures was performed. After surgery, the patient went to the intensive care unit; immediately after her arrival there, intra-abdominal bleeding was confirmed through the drainage bag. Therefore, she underwent a second emergency laparotomy. Vessels near the superior mesenteric artery under the transverse mesocolon were damaged. We could not find the definite bleeding focus because massive bleeding obscured vision, and the patient’s blood pressure was unstable. We thus performed resuscitative endovascular balloon occlusion of the aorta (REBOA) intraoperatively. The balloon was placed in zone I of the aorta, but for various reasons, we could not pinpoint the location of the catheter in operating room (Fig. 2.). After bleeder ligation and deflation of the balloon, there was no more active bleeding. The balloon was maintained for 21 minutes Treatment Progression in Trauma eISSN: 2508-8033 pISSN: 2508-5298
一名63岁的妇女遭遇车祸;她一直坐在副驾驶座上。在急诊室，患者血压82/46 mm Hg，脉搏84次/分，意识正常。下腹部擦伤，有安全带标志(图1)。外伤性超声扩展聚焦评估显示莫里森袋和膀胱周围有中度至重度腹内积液。血红蛋白8.8 g/dL，乳酸1.82 mmol/L。没有进行进一步的影像学检查，并立即进行探查手术。手术表现为横结肠和横结肠系膜穿孔。进行初级缝合修复。手术后，病人去了重症监护室;她到达医院后，立即通过引流袋确认腹部出血。因此，她接受了第二次紧急剖腹手术。横结肠系膜下肠系膜上动脉附近的血管受损。由于大出血模糊视力，患者血压不稳定，无法明确出血病灶。因此，我们在术中进行了复苏血管内球囊阻断主动脉(REBOA)。球囊放置在主动脉I区，但由于各种原因，我们无法在手术室精确定位导管的位置(图2)。在止血结扎和气球放气后，没有更多的活动性出血。治疗进展:创伤eISSN: 2508-8033 pISSN: 2508-5298
{"title":"Intraoperative Application of Resuscitative endovascular balloon occlusion of the aorta (REBOA) to Traumatic Vascular Injury","authors":"J. Ko, P. Y. Jung","doi":"10.24184/tip.2019.4.1.12","DOIUrl":"https://doi.org/10.24184/tip.2019.4.1.12","url":null,"abstract":"A 63-year-old woman was in a car accident; she had been sitting in the passenger seat. In the emergency room, the patient’s blood pressure was 82/46 mm Hg, the pulse rate was 84 beats/min, and her level of consciousness was normal. The lower abdomen was bruised with a seat belt sign (Fig. 1.). The extended focused assessment sonography in trauma showed a moderate to severe intra-abdominal fluid collection in Morison's pouch and in perivesical sites. The hemoglobin level was 8.8 g/dL, and the lactate level was 1.82 mmol/L. No further imaging tests were performed, and exploratory surgery proceeded immediately. The operative findings were perforations of the transverse colon and transverse mesocolon. Repair with primary sutures was performed. After surgery, the patient went to the intensive care unit; immediately after her arrival there, intra-abdominal bleeding was confirmed through the drainage bag. Therefore, she underwent a second emergency laparotomy. Vessels near the superior mesenteric artery under the transverse mesocolon were damaged. We could not find the definite bleeding focus because massive bleeding obscured vision, and the patient’s blood pressure was unstable. We thus performed resuscitative endovascular balloon occlusion of the aorta (REBOA) intraoperatively. The balloon was placed in zone I of the aorta, but for various reasons, we could not pinpoint the location of the catheter in operating room (Fig. 2.). After bleeder ligation and deflation of the balloon, there was no more active bleeding. The balloon was maintained for 21 minutes Treatment Progression in Trauma eISSN: 2508-8033 pISSN: 2508-5298","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"80 7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130785733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 41-year-old man presented to the emergency department after a pedestrian traffic accident. The initial vital signs were unstable: systolic blood pressure, 80 mm Hg; pulse rate, 56 beats/min; respiration rate, 16 breaths/min; body temperature, 36.0°C; and oxygen saturation, 95%. Early abdominal computed tomography (CT) of the right side of the liver showed American Association for the Surgery of Trauma (AAST) grade IV injury, according to the Organ Injury Scale (OIS) score, with extravasation of contrast material (Fig. 1.). On the same day, hepatic artery angiography showed active bleeding in segments 5, 7, and 8, and embolization was performed (Fig. 2.). Liver enzyme levels (aspartate aminotransferase, 1036 IU/L; alanine transferase, 1192 IU/L) were highest on day 3 after admission. No extravasation of contrast material was observed on abdominal CT performed on day 3 (Fig. 3.). On day 5, the patient developed abdominal pain in the right upper quadrant. The focus of pain was more lateral than the location of the gallbladder on initial abdominal CT, and tenderness was also observed on physical examination. On abdominal ultrasonography, biloma was observed in the hepatic dome. Therefore, percutaneous drainage was performed (Fig. 4.). Biloma was still observed on abdominal CT 2 weeks later (Fig. 5.).
一名41岁男子在一次行人交通事故后被送往急诊室。初始生命体征不稳定:收缩压80 mm Hg;脉搏率:56次/分;呼吸频率:16次/分;体温36.0℃;氧饱和度，95%。根据器官损伤分级(OIS)评分，早期右侧肝脏腹部计算机断层扫描(CT)显示美国创伤外科协会(AAST) IV级损伤，并有造影剂外渗(图1)。同日，肝动脉造影显示5、7、8段活动性出血，行栓塞术(图2)。肝酶水平(天冬氨酸转氨酶，1036 IU/L;丙氨酸转移酶1192 IU/L)在入院后第3天最高。第3天腹部CT未见造影剂外渗(图3)。第5天，患者出现右上腹腹痛。在最初的腹部CT上，疼痛的焦点比胆囊的位置更外侧，体格检查也观察到压痛。腹部超声检查发现肝穹窿有胆囊瘤。因此，我们进行了经皮引流术(图4)。2周后腹部CT上仍可见胆囊瘤(图5)。
{"title":"Sonographic Diagnosis of Biloma in Severe Traumatic Liver Injury","authors":"C. Park, Wu-Seong Kang, S. Seo, S. Moon","doi":"10.24184/tip.2019.4.1.6","DOIUrl":"https://doi.org/10.24184/tip.2019.4.1.6","url":null,"abstract":"A 41-year-old man presented to the emergency department after a pedestrian traffic accident. The initial vital signs were unstable: systolic blood pressure, 80 mm Hg; pulse rate, 56 beats/min; respiration rate, 16 breaths/min; body temperature, 36.0°C; and oxygen saturation, 95%. Early abdominal computed tomography (CT) of the right side of the liver showed American Association for the Surgery of Trauma (AAST) grade IV injury, according to the Organ Injury Scale (OIS) score, with extravasation of contrast material (Fig. 1.). On the same day, hepatic artery angiography showed active bleeding in segments 5, 7, and 8, and embolization was performed (Fig. 2.). Liver enzyme levels (aspartate aminotransferase, 1036 IU/L; alanine transferase, 1192 IU/L) were highest on day 3 after admission. No extravasation of contrast material was observed on abdominal CT performed on day 3 (Fig. 3.). On day 5, the patient developed abdominal pain in the right upper quadrant. The focus of pain was more lateral than the location of the gallbladder on initial abdominal CT, and tenderness was also observed on physical examination. On abdominal ultrasonography, biloma was observed in the hepatic dome. Therefore, percutaneous drainage was performed (Fig. 4.). Biloma was still observed on abdominal CT 2 weeks later (Fig. 5.).","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124049950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Confusing Finding in Hepatic Injury With Diaphragmatic Rupture","authors":"P. Y. Jung","doi":"10.24184/tip.2019.4.1.1","DOIUrl":"https://doi.org/10.24184/tip.2019.4.1.1","url":null,"abstract":"","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117131187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-31DOI: 10.24184/tip.2019.4.1.25
D. H. Kim
The following three patients with stab injuries of abdomen were hemodynamically stable; physical examination of their abdomens revealed no diffuse peritoneal irritation. Computed tomographic scans of their abdomens showed penetration of the fascia and the presence of free fluid without definite intra-abdominal organ injury. Diagnostic laparoscopy was performed in those patients and demonstrated no intra-abdominal organ injury except for peritoneal laceration. Laparoscopic techniques of peritoneal repair are described as follows: 1. A 24-year-old woman with significant two stab injuries in the upper abdomen (left lower chest wall, 1.5 cm long, and right upper quadrant, 2.5 cm long) underwent laparoscopic primary repair of peritoneum. Intracorporeally simple suturing with Vicryl 3-0 were performed on peritoneal lacerations (Video 1). 2. A 32-year-old man with stab injury (2.7 cm long) in the right upper quadrant underwent laparoscopic primary repair of the peritoneum with barbed sutures. The peritoneal laceration was continuously sutured with knotless, unidirectional, barbed monofilament absorbable sutures (V-Loc; Video 2). 3. A 50-year-old woman with a stab injury (1.2 cm long) in the right upper quadrant underwent surgery under laparoscopic view. The suture passer was pulled through each fascia margin of the wound so that the end of each prepared suture rested in the abdominal cavity. On the injured fascia, a knot was extracorporeally tied, and peritoneal repair was completed (Video 3).
{"title":"Laparoscopic Peritoneal Repair for Stab Injury","authors":"D. H. Kim","doi":"10.24184/tip.2019.4.1.25","DOIUrl":"https://doi.org/10.24184/tip.2019.4.1.25","url":null,"abstract":"The following three patients with stab injuries of abdomen were hemodynamically stable; physical examination of their abdomens revealed no diffuse peritoneal irritation. Computed tomographic scans of their abdomens showed penetration of the fascia and the presence of free fluid without definite intra-abdominal organ injury. Diagnostic laparoscopy was performed in those patients and demonstrated no intra-abdominal organ injury except for peritoneal laceration. Laparoscopic techniques of peritoneal repair are described as follows: 1. A 24-year-old woman with significant two stab injuries in the upper abdomen (left lower chest wall, 1.5 cm long, and right upper quadrant, 2.5 cm long) underwent laparoscopic primary repair of peritoneum. Intracorporeally simple suturing with Vicryl 3-0 were performed on peritoneal lacerations (Video 1). 2. A 32-year-old man with stab injury (2.7 cm long) in the right upper quadrant underwent laparoscopic primary repair of the peritoneum with barbed sutures. The peritoneal laceration was continuously sutured with knotless, unidirectional, barbed monofilament absorbable sutures (V-Loc; Video 2). 3. A 50-year-old woman with a stab injury (1.2 cm long) in the right upper quadrant underwent surgery under laparoscopic view. The suture passer was pulled through each fascia margin of the wound so that the end of each prepared suture rested in the abdominal cavity. On the injured fascia, a knot was extracorporeally tied, and peritoneal repair was completed (Video 3).","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"95 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116494267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-31DOI: 10.24184/tip.2019.4.1.22
P. Y. Jung, K. Kim
From a regional local hospital, a 34-year-old man who had schizophrenia was transferred to our institution with multiple stab injuries of the trunk, sustained in a suicide attempt (Fig. 1.). At admission, the patient’s vital signs were unstable; cardiac arrest occurred, and return of spontaneous circulation was achieved after one cycle of cardiopulmonary resuscitation. The extended focused assessment sonography in trauma revealed positive signs in the pericardium and splenorenal space. Computed tomographic scans taken at the previous hospital showed hemopericardium and hemoperitoneum (Fig. 2.). Emergency surgery of the chest and abdomen was begun simultaneously. During opening of the chest with median sternotomy, cardiac arrest occurred again; We performed open cardiac massage, and spontaneous circulation resumed. The surgical finding was a complete transection of the left internal mammary vessels, which was the cause of hemopericardium (Fig. 3.). The epicardium of the right ventricle, the greater omentum, and the spleen were injured; the diaphragmatic injury may have served as a pericardial window of injury into the abdomen cavity. We performed ligation of the left internal mammary vessels, splenectomy, omentectomy, and primary repair of the diaphragm. The patient recovered and was discharged without any complication 24 days after admission (Fig. 4.).
{"title":"Pericardial Injury With Cardiac Tamponade From Multiple Stab Injuries of the Trunk: Incidental Release of Cardiac Tamponade","authors":"P. Y. Jung, K. Kim","doi":"10.24184/tip.2019.4.1.22","DOIUrl":"https://doi.org/10.24184/tip.2019.4.1.22","url":null,"abstract":"From a regional local hospital, a 34-year-old man who had schizophrenia was transferred to our institution with multiple stab injuries of the trunk, sustained in a suicide attempt (Fig. 1.). At admission, the patient’s vital signs were unstable; cardiac arrest occurred, and return of spontaneous circulation was achieved after one cycle of cardiopulmonary resuscitation. The extended focused assessment sonography in trauma revealed positive signs in the pericardium and splenorenal space. Computed tomographic scans taken at the previous hospital showed hemopericardium and hemoperitoneum (Fig. 2.). Emergency surgery of the chest and abdomen was begun simultaneously. During opening of the chest with median sternotomy, cardiac arrest occurred again; We performed open cardiac massage, and spontaneous circulation resumed. The surgical finding was a complete transection of the left internal mammary vessels, which was the cause of hemopericardium (Fig. 3.). The epicardium of the right ventricle, the greater omentum, and the spleen were injured; the diaphragmatic injury may have served as a pericardial window of injury into the abdomen cavity. We performed ligation of the left internal mammary vessels, splenectomy, omentectomy, and primary repair of the diaphragm. The patient recovered and was discharged without any complication 24 days after admission (Fig. 4.).","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"109 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127065721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-31DOI: 10.24184/tip.2019.4.1.15
C. Park, Sora Ahn, Wu-Seong Kang, S. Seo, S. Moon
the complications of splenic injury not managed surgically. However, delayed pseudoaneurysm rupture in low-grade splenic injury is extremely rare. I report the case of a 74-year-old man with low-grade splenic injury who suffered delayed pseudoaneurysm rupture. The patient was admitted with low-grade splenic injury (grade II Organ Injury Scale [OIS] score according to the American Association for the Surgery of Trauma [AAST]). On chest computed tomography on day 6, a pseudoaneurysm approximately 2.5 × 1.5 × 2.5 cm in size appeared in the spleen; however, the physician missed this finding at that time. On day 13, chest computed tomography confirmed pseudoaneurysm rupture. The ruptured pseudoaneurysm was successfully treated with transcatheter arterial embolization. This rare case is reported to describe the entire process from occurrence to rupture of the splenic pseudoaneurysm in a low-grade splenic injury.
{"title":"A Delayed Pseudoaneurysm Rupture in Low-Grade Splenic Injury","authors":"C. Park, Sora Ahn, Wu-Seong Kang, S. Seo, S. Moon","doi":"10.24184/tip.2019.4.1.15","DOIUrl":"https://doi.org/10.24184/tip.2019.4.1.15","url":null,"abstract":"the complications of splenic injury not managed surgically. However, delayed pseudoaneurysm rupture in low-grade splenic injury is extremely rare. I report the case of a 74-year-old man with low-grade splenic injury who suffered delayed pseudoaneurysm rupture. The patient was admitted with low-grade splenic injury (grade II Organ Injury Scale [OIS] score according to the American Association for the Surgery of Trauma [AAST]). On chest computed tomography on day 6, a pseudoaneurysm approximately 2.5 × 1.5 × 2.5 cm in size appeared in the spleen; however, the physician missed this finding at that time. On day 13, chest computed tomography confirmed pseudoaneurysm rupture. The ruptured pseudoaneurysm was successfully treated with transcatheter arterial embolization. This rare case is reported to describe the entire process from occurrence to rupture of the splenic pseudoaneurysm in a low-grade splenic injury.","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127330649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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