Medicine · 2025
Damage control strategy involving early strategic decision-making and staged surgical management in a hybrid emergency room system: A case report.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Tokumaru Teppei, Okabayashi Takehiro, Saisaka Yuichi, Kurata Hideaki, Hata Michiaki, Tomioka Joji
Аннотация
RATIONALE: The hybrid emergency room system (HERS) has gained recognition for enabling rapid diagnosis and intervention in trauma care. However, it remains unclear whether its benefits stem solely from the availability of integrated technology or from facilitating early strategic decision-making by the trauma team.
PATIENT CONCERNS: A 58-year-old woman was involved in a motor vehicle collision and sustained severe injuries, including a diaphragmatic rupture, multiple left rib fractures, and thoracolumbar vertebral fractures. Despite initial resuscitation at a referring hospital, she remained hemodynamically unstable.
DIAGNOSES: Upon arrival at our HERS-equipped facility, imaging and clinical assessment confirmed traumatic diaphragmatic rupture, flail chest, and unstable thoracolumbar vertebral fractures.
INTERVENTIONS: A multidisciplinary team was mobilized based on prearrival information, and an early treatment strategy was established. Emergency laparotomy was initiated 26 minutes after arrival for hemorrhage control, followed by staged rib fixation and spinal stabilization surgeries in accordance with her physiological condition.
OUTCOMES: The patient recovered fully with no neurological deficits and was discharged in good general condition after completing all staged interventions.
LESSONS: This case suggests that the effectiveness of HERS lies not only in its integrated infrastructure but also in its capacity to enable early strategic decision-making and coordinated staged interventions. These principles may be adaptable to non-HERS trauma centers that emphasize early information sharing and multidisciplinary planning.
PATIENT CONCERNS: A 58-year-old woman was involved in a motor vehicle collision and sustained severe injuries, including a diaphragmatic rupture, multiple left rib fractures, and thoracolumbar vertebral fractures. Despite initial resuscitation at a referring hospital, she remained hemodynamically unstable.
DIAGNOSES: Upon arrival at our HERS-equipped facility, imaging and clinical assessment confirmed traumatic diaphragmatic rupture, flail chest, and unstable thoracolumbar vertebral fractures.
INTERVENTIONS: A multidisciplinary team was mobilized based on prearrival information, and an early treatment strategy was established. Emergency laparotomy was initiated 26 minutes after arrival for hemorrhage control, followed by staged rib fixation and spinal stabilization surgeries in accordance with her physiological condition.
OUTCOMES: The patient recovered fully with no neurological deficits and was discharged in good general condition after completing all staged interventions.
LESSONS: This case suggests that the effectiveness of HERS lies not only in its integrated infrastructure but also in its capacity to enable early strategic decision-making and coordinated staged interventions. These principles may be adaptable to non-HERS trauma centers that emphasize early information sharing and multidisciplinary planning.