Management of chest impalement injury

A case of cardiac impalement injury with severe shock treated surgically after diagnosis using computed tomography and managed via extracorporeal membrane oxygenation in the hybrid emergency room

The Hybrid Emergency Room System (HERS) allows clinicians to perform life-saving procedures without having to transfer patients. Several studies have reported the effectiveness of the HERS in the treatment of blunt trauma patients. However, the use of a hybrid emergency room (ER) for the treatment of penetrating cardiac injuries, including impalement injuries, has not been reported. We present the case of a patient with cardiac impalement injury that was diagnosed via computed tomography (CT) and was managed via extracorporeal membrane oxygenation (ECMO) in the hybrid ER and via surgery in the operating room. A 55-year-old man was transferred to our hybrid ER due to a penetrating wood injury through the right thoracic region. The patient had unstable vital signs. A CT scan revealed a pericardial effusion, right lung contusion, and bilateral pneumothoraxes. There were no signs of hemothorax or aortic injury. Veno-arterial-ECMO was performed in preparation for surgery. The patient was then transferred to the operating room. Pericardiotomy and cardiac repair were performed, and the ECMO was discontinued postoperatively. The patient was discharged on postoperative day 10 without complications. The hybrid ER allows rapid CT examination without relocation. Thus, it facilitates the formation of a timely and effective treatment plan. This report documents the successful management of a cardiac impalement injury in the HERS.

Pre-Hospital and In-Hospital Management of an Abdominal Impalement Injury Caused by a Tree Branch

In South Korea, most patients who visit trauma centers with abdominal injuries have blunt trauma, and penetrating injuries are relatively rare. In extremely rare cases, some patients are admitted with a long object penetrating their abdomen, and these injuries are referred to as abdominal impalement injuries. Most cases of impalement injuries lead to fatal bleeding, and patients often die at the scene of the accident. However, patients who survive until reaching the hospital can have a good prognosis with optimal treatment. A 68-year-old female patient was admitted to the trauma center with a 4-cm-thick tree branch impaling her abdomen. The patient was transported by a medical helicopter and had stable vital signs at admission. The branch sticking out of the abdomen was quite long; thus, we carefully cut the branch with an electric saw to perform computed tomography (CT). CT revealed no signs of major blood vessel injury, but intestinal perforation was observed. During laparotomy, the tree branch was removed after confirming that there were no vascular injuries, and enterostomy was performed because of extensive intestinal injury. After treating other injuries, the patient was discharged without any complications except colostomy. Abdominal impalement injuries are treated using various approaches depending on the injury mechanism and injured region. However, the most important consideration is that the impaled object should not be removed during transportation and resuscitation. Instead, it should only be removed after checking for injuries to blood vessels during laparotomy in an environment where injury control is possible.

Acute Cycling Injuries

The overall activity of cycling, although profoundly heterogenous, often occurs with mechanisms consistent with motor vehicle collisions. Advanced trauma life support is the standard of care. Traumatic brain injury is the leading cause of death, and concussions are common in cyclists. Road rash is the most common injury, and management should be synonymous with other kinds of burns. A unique aspect of cycling medicine is that it often is done on public roadways in close proximity to the athletes during competition. Clinicians who care for cyclists in the field setting should be prepared to manage a broad spectrum of traumatic injuries.