Keiji Sakurai

Atypical extravasation of contrast medium in massive extrapleural haematoma due to cardiac massage without rib fracture.

A 72-year-old man was admitted to the emergency department with a diagnosis of inferior myocardial infarction. During intervention with heparin, ventricular fibrillation suddenly occurred. Twelve minutes after resuscitation he was successfully defibrillated with cardiac massage and defibrillation therapy. His respiratory condition progressively worsened and the …

Impact of emergency physicians competent in severe trauma management, surgical techniques, and interventional radiology on trauma management

Despite recent advancements in trauma management following introduction of interventional radiology (IVR) and damage‐control strategies, challenges remain regarding optimal use of resources for severe trauma.

Importance of the capability for complete resuscitative treatment combining surgery and interventional radiology for potentially lethal multiple injuries: A case report

Background Recently, trauma management has been complicated owing to the introduction of damage-control strategies and interventional radiology. Here, we discuss important aspects regarding survival of patients with severe trauma. Case presentation A 74-year-old Japanese woman experienced a traffic accident on a highway. On arrival, paramedics were unable to measure her blood pressure, and her condition deteriorated. The patient was immediately transferred to our hospital in a physician-staffed emergency helicopter, during which she was administered emergency blood transfusions. On admission, her systolic blood pressure was 44 mmHg, and focused assessment with sonography for trauma yielded positive findings at the anterior mediastinum, right thoracic cavity, and intra-abdominal cavity. Plain radiography revealed a partial unstable-type pelvic fracture. Immediately, cardiac tamponade caused by the massive anterior mediastinal hematoma with internal thoracic vessel injuries was diagnosed through a median sternotomy, while a diaphragmatic rupture and hemorrhage from the intra-abdominal cavity were diagnosed through right anterior-lateral thoracotomy. Furthermore, massive bowel and mesenteric vessel injuries were diagnosed through laparotomy; all of these injuries were treated sequentially as a simplified process. The patient then underwent transcatheter arterial embolization for the retroperitoneal hematoma and the pelvic fracture. Reestablishing intestinal continuity was performed after intensive care. All procedures were seamlessly performed by trained emergency physicians, and the postoperative course was uneventful, with the patient recovering completely after rehabilitation. Conclusions The capability to perform complete resuscitative treatments that seamlessly combine surgery and interventional radiology in the appropriate order is important for the survival of patients with multiple traumatic injuries.

Use of interventional radiology as initial hemorrhage control to improve outcomes for potentially lethal multiple blunt injuries

INTRODUCTION Recently, trauma management has been markedly improved with interventional radiology (IVR) and damage-control strategies. However, the indications for its use in hemodynamically unstable patients with severe trauma remains unclear. In some cases, IVR may be more effective than surgery for damage-control hemostasis; however, performing IVR in life-threatening trauma settings is challenging. To address this, we practiced and evaluated a trauma-management system with emergency physicians who trained for both severe trauma management, and techniques of surgery and IVR. MATERIALS AND METHODS Among the 1822 patients with severe trauma admitted between October 2014 and December 2016, 201 underwent emergency surgery or IVR. Among these, 16 patients whose systolic blood pressure was ≤90 mmHg, without improvement following primary resuscitation, and whose first intervention was IVR, were analyzed. We retrospectively evaluated the admission characteristics, IVR-related characteristics, and prognoses, and compared several parameters before and after IVR. RESULTS This study included 10 men and 6 women (median age: 46 years). IVR was performed for 10 pelvic fractures; five liver-, one splenic-, and one renal injury; and one transection each of the external carotid-, vertebral-, axillosubclavian-, intercostal-, and lumbar arteries. The mean times from the patient arrival, and diagnosis to the start of IVR were 56.3 ± 26.6 and 15.1 ± 3.8 min, respectively. The mean time spent in the angiography suite was 50 min. The systolic blood pressure, pulse rate, base excess/deficit, serum-lactate levels, and D-dimer values were significantly improved after IVR. Although two patients needed additional treatment for morbidities following IVR intervention, all achieved complete recovery. The mortality rate was 25.0%, and no preventable deaths were noted. Eight patients showed unexpected survival. CONCLUSIONS In some cases, IVR may be the best first measure for resuscitative hemostasis in potentially lethal multiple injuries, given efficient diagnoses/actions and the ability to deal with complications.

A giant abdominal hematoma caused by seatbelt injury led to the development of shock

Trauma to soft tissues is an important consideration in cases of seatbelt injury, as soft‐tissue injury can cause shock. Careful observation for hours in the clinic at least, along with appropriate imaging studies, is necessary if signs of a seatbelt injury exist.

Plasma lactate concentration as an indicator of plasma caffeine concentration in acute caffeine poisoning

Severe caffeine poisoning is rare, but is associated with high mortality. Plasma caffeine concentration is one of the indications of treatment of caffeine poisoning; however, it is not easily measured at most emergency departments. If the plasma lactate concentration and the plasma caffeine concentration were correlated, the plasma lactate concentration may be an indication of caffeine poisoning. In this study, we investigated the correlation between the plasma lactate concentration and the plasma caffeine concentration.