RESUMO
Blunt vertebral artery injuries (BVAI) associated with cervical spine fractures are often problematic due to symptoms of occlusion. Denver grade V cases, in which the vertebral artery is transected, are rare but often fatal, and treatment has rarely been reported. We encountered a case of hemorrhagic shock due to an injury to a branch of the vertebral artery associated with an upper cervical spine fracture. Transcatheter arterial embolization was performed successfully to achieve hemostasis, requiring superselective arterial embolization to preserve the main trunk of the vertebral artery. It is important to be aware that vascular injuries to the branch vessels as well as the main trunk can cause complications.
RESUMO
Massive subdural hematomas are known to cause hemorrhagic shock in infants and young children. Traumatic cerebral aneurysms are rare and are often noticed in the subacute phase with disorientation due to the rupture of a pseudoaneurysm. No previous studies appear to have clarified the diagnosis of and therapeutic interventions for traumatic cerebral aneurysms identified from computed tomography (CT) on admission. The present case involved an open skull fracture resulting in hemorrhagic shock due to subcutaneous extravasation from an anterior cerebral artery (ACA) pseudoaneurysm. A seven-year-old boy was accidentally struck by a car after running out into a road. He had an open fracture of the skull and contrast-enhanced CT of the head showed subcutaneous extravasation from the ACA. The patient developed hemorrhagic shock that resolved following the embolization of the ACA with n-butyl-2-cyanoacrylate. Head trauma can cause hemorrhagic shock in the presence of an open wound due to a skull fracture. Contrast-enhanced CT of the head on admission is useful for diagnosis.
RESUMO
Background: Hypocalcemia has been reported as an independent predictor of trauma mortality. We investigated the relationship between temporal variations in blood ionized calcium concentration (iCa) and prognosis in severe trauma patients who underwent massive transfusion protocol (MTP). Methods: This single-center, retrospective, observational study investigated 117 severe trauma patients treated with MTP in the Department of Emergency Medicine and Critical Care, Saitama Medical Center, Saitama Medical University, between March 2013 and March 2019. Multivariate logistic regression analysis was performed, assigning pH-corrected initial and minimum blood ionized calcium concentration within 24 hours of admission (iCa_min), age, initial systolic blood pressure and Glasgow Coma Scale (GCS) score, and incidence of Ca supplementation as independent variables and 28-day mortality as dependent variable. Results: The logistic regression analysis identified iCa_min (adjusted OR 0.03, 95% CI 0.002 to 0.4), age (adjusted OR 1.05, 95% CI 1.02 to 1.09), and GCS score (adjusted OR 0.84, 95% CI 0.74 to 0.94) as significant independent predictors of 28-day mortality. The receiver operating characteristic analysis identified optimal cut-off value of iCa_min for predicting 28-day mortality as 0.95 mmoL/L (area under the curve 0.74). Conclusion: In the management of patients with traumatic hemorrhagic shock, aggressive correction of the iCa to maintain 0.95 mmol/L or higher within 24 hours of admission may improve short-term outcomes. Level of evidence: Therapeutic/care management, level III.
RESUMO
Liver injury, especially caudate lobe injury, is an extremely rare form of injury in infants. In most cases, liver injury results in intraperitoneal hemorrhage when the capsule is ruptured, and circulatory dynamics deteriorate early. Caudate lobe injuries, however, often present with a high retroperitoneal hematoma. The diagnosis is difficult to identify with a focused assessment with sonography for trauma (FAST) in the initial treatment of trauma and may even be delayed without contrast-enhanced CT imaging. A one-month-old postoperative boy with congenital heart disease was involved in a motor vehicle accident and presented with a single caudate lobe injury. He was not wearing a seatbelt, and it was thought that the caudate lobe was injured due to shearing forces in the cephalocaudal direction at the time of the accident. The patient did not go into shock when he first came to our hospital, but a few hours after admission, he went into shock and required surgical hemostasis. The postoperative course was good, and the patient was discharged alive one month later. The lesson to be learned from this case is that caudate lobe injuries are often associated with retroperitoneal hematoma and slow deterioration of hemodynamics, so it is important not to miss small changes in the child's vitals and to be willing to perform contrast-enhanced CT imaging depending on the type of injury.
