A pediatric case of multiple trauma with impending cardiac arrest due to hemorrhagic shock successfully treated with resuscitative thoracotomy: A case report.

Background: The effectiveness of resuscitative thoracotomy (RT) in pediatric patients with multiple trauma is limited. We present a pediatric case of multiple trauma successfully treated with RT. Case Presentation: A 9-year-old boy was injured after falling down stairs. On arrival, his blood pressure was unmeasurable, and the carotid artery pulse was barely palpable. Sonographic assessment indicated intra-abdominal hemorrhage. RT and aortic cross-clamping were performed, and he received a blood transfusion, after which his circulatory status recovered. Laparotomy indicated an inferior mesenteric vein injury that was sutured. Ten hours after arrival, an acute epidural hematoma was observed and treated with an emergency craniotomy. The patient's condition remained stable and he was discharged on the 101st day. Conclusion: RT may save the life of patients with multiple trauma, even pediatric patients, if performed in a timely manner, based on the diagnosis of hemorrhagic shock, along with rapid transfusion and hemostatic intervention.

Physician-Staffed Emergency Vehicle Crash: A Case Report.

Physician-staffed vehicles are widely operated in many countries. There is a paucity of literature regarding physician-staffed emergency vehicle accidents. On an evening in January 2016, at the request of the fire department, a physician-staffed vehicle was dispatched with two physicians, a nurse, and a driver from the base hospital to the scene of a patient with cardiopulmonary arrest. The vehicle ran with the alerting siren and warning lights. On its way, the vehicle struck a car and the mission was canceled. The patient was transported to another hospital by the ambulance staff only. No passengers were injured. One physician and a nurse examined the driver of the struck car and transported the driver to the base hospital by additional ambulance units. Because there were no manuals or guidelines, the staff responses were not systematic. After the repair of the crashed vehicle and preparation of operation manuals for two months, the physician-staffed vehicle returned to service, and it has worked without any accident since then. The physician-staffed vehicle is of benefit to critical victims and it rarely crashes. When the vehicle is involved in an accident, it results in multiple victims as well as additional emergency demands. Warning lights and sirens in the dark at a four-point crossroads might increase the risk of crashing. Information influx from the emergency scenes might distract the physicians' attention and put stress on the driver, leading to dangerous high-speed emergency driving. Educational training and manuals in each hospital and a nationwide framework regarding safety operations and accidents are needed.

Complement Activation in Human Sepsis is Related to Sepsis-Induced Disseminated Intravascular Coagulation.

INTRODUCTION: In human sepsis, little is known about the relationships between complement activation and the clinical characteristics of sepsis, including disseminated intravascular coagulation (DIC), interventions, and prognosis. PATIENTS AND METHODS: Adult patients with sepsis admitted from November 2016 to December 2018 were included. We used the plasma levels of soluble C5b-9 (SC5b-9) as a marker of complement activation. We compared the clinical characteristics and complement components between patients with and without DIC. We also compared the clinical characteristics and each DIC parameter across quartile groups for the SC5b-9 value. RESULTS: Forty-nine sepsis patients were eligible. Thirty-four patients developed DIC, and eight patients died. The median (interquartile range) SC5b-9 value was 342 (261-501) ng/mL. Compared with patients without DIC, patients with DIC showed lower C3 levels (mean, 95.7 vs. 70.4 mg/dL, P < 0.01) and higher SC5b-9 levels (median, 287 vs. 400 ng/mL, P = 0.01). Patients were stratified by SC5b-9 quartile (ng/mL: low: < 260, moderate: 260-342, high: 343-501, highest: > 501). The mean Sequential Organ Failure Assessment score varied across these groups (P = 0.02). In the high and highest groups, many more patients received vasopressors and developed DIC. In the highest group, the coagulation parameters were severe, and thrombocytopenia was prolonged. In-hospital mortality tended to be high (33%) in the highest group. CONCLUSIONS: The degree of complement activation is related to DIC, severity, intensive interventions, and mortality. Further studies are needed to confirm the usefulness of SC5b-9 for stratifying sepsis patients.

Primary repair of posterior cruciate ligament avulsion fracture: the effect of occult injury in the midsubstance on postoperative instability.

BACKGROUND: In the posterior cruciate ligament avulsion fracture, posterior instability cannot be completely restored by the anatomical reduction and fixation of an avulsed fragment. HYPOTHESIS: The occult midsubstance injury inside the posterior cruciate ligament may affect the residual posterior instability after anatomical reduction and internal fixation of the avulsed fragment. STUDY DESIGN: Prospective comparative clinical study. METHODS: Thirty-one patients were followed for a period of 2 to 8 years. Based on magnetic resonance images taken immediately after the injury, these patients were divided into 2 groups, the occult injury group (group O, 15 knees) and the uninjured group (group N, 16 knees). RESULTS: The side-to-side difference of the posterior knee instability was 3.2 mm in group O and 3.0 mm in group N. Approximately 60% of the knees examined showed mild posterior instability in both groups. There were no significant differences found between the 2 groups. CONCLUSION: The occult posterior cruciate ligament midsubstance injury does not significantly affect postoperative posterior instability of the knee. This fact did not support the hypothesis that has been commonly considered thus far. CLINICAL RELEVANCE: It is not necessary for orthopaedic surgeons to be overly apprehensive about occult midsubstance injury in the treatment of posterior cruciate ligament avulsion fracture.