Journal of Emergencies, Trauma, and Shock
Home About us Editors Ahead of Print Current Issue Archives Search Instructions Subscribe Advertise Login 
Users online:254   Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size   


 
 Table of Contents    
LETTER TO EDITOR  
Year : 2015  |  Volume : 8  |  Issue : 2  |  Page : 125-126
Successful treatment of a penetrating pulmonary artery injury caused by a Japanese sword in a patient transported by a physician-staffed helicopter


Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Shizuoka, Japan

Click here for correspondence address and email

Date of Web Publication21-Apr-2015
 

How to cite this article:
Ohsaka H, Yanagawa Y, Miyasaka Y, Okamoto K. Successful treatment of a penetrating pulmonary artery injury caused by a Japanese sword in a patient transported by a physician-staffed helicopter. J Emerg Trauma Shock 2015;8:125-6

How to cite this URL:
Ohsaka H, Yanagawa Y, Miyasaka Y, Okamoto K. Successful treatment of a penetrating pulmonary artery injury caused by a Japanese sword in a patient transported by a physician-staffed helicopter. J Emerg Trauma Shock [serial online] 2015 [cited 2018 Jul 22];8:125-6. Available from: http://www.onlinejets.org/text.asp?2015/8/2/125/145393


Sir,

We herein present a case of successful treatment of a penetrating pulmonary artery injury caused by a Japanese sword (katana) in a patient transported by a physician-staffed helicopter. A 91-year-old male stabbed his chest and abdomen and cut his head with a katana and was found in a coma by his family. His history included dementia, schizophrenia, hypertension, and diabetes mellitus. A physician transported by a helicopter checked the patient at a rendezvous point in an ambulance and found that the katana had penetrated the patient's body from the fourth intercostal of the left anterior chest to the back [Figure 1]. The patient was in a deep coma and also a state of severe hemorrhagic shock. His venous route and airway were secured, and he was transported to our hospital. He remained in a coma with shock and demonstrated left pneumoderma in the left chest; therefore, he underwent placement of an indwelling chest tube, followed by drainage of 500 ml of hemorrhagic fluid. Permissive hypotensive therapy to maintain the systolic blood pressure from 60 to 80 mmHg was selected with transfusion of blood type O, and emergency thoracotomy was performed in the operating room. The patient temporally exhibited pulseless electrical activity due to massive hemorrhage, and fluid resuscitation resulted in spontaneous circulation. Injuries of the lingual, left pulmonary artery, and diaphragm were found, and primary closure of the pulmonary artery with clamping of the pulmonary hilum, primary closure of the diaphragm, and lobectomy of the lingual region were performed. The abdominal stab wound did not reach the intra-abdominal cavity and was also closed. After the operation, the patient developed pyothorax and was treated with antibiotics. He achieved a full somatic recovery and was transferred to a psychiatric hospital. The patient was successfully treated, despite his advanced age and severe shock state resulting from injury of major thoracic vessels. [1],[2],[3],[4] The key to success was a multidisciplinary approach, including early medical intervention, transportation using a physician-staffed helicopter, and the administration of permissive hypotensive treatment and emergency thoracotomy with clamping of the pulmonary hilum.
Figure 1: A katana penetrates a patient's body from the fourth intercostal of the left anterior chest to the back

Click here to view


 
   References Top

1.
Fatimi SH, Hanif HM, Awais A, Shamsi G, Muzaffar M. Major thoracic vessels and cardiac trauma: Case series from a center in a developing country. Ulus Travma Acil Cerrahi Derg 2012;18:490-4.   Back to cited text no. 1
    
2.
Onan B, Demirhan R, Öz K, Onan IS. Cardiac and great vessel injuries after chest trauma: Our 10-year experience. Ulus Travma Acil Cerrahi Derg 2011;17:423-9.  Back to cited text no. 2
    
3.
Mandal AK, Sanusi M. Penetrating chest wounds: 24 years experience. World J Surg 2001;25:1145-9.  Back to cited text no. 3
    
4.
Baillot R, Dontigny L, Verdant A, Pagé P, Pagé A, Mercier C, et al. Penetrating chest trauma: A 20-year experience. J Trauma 1987;27:994-7.  Back to cited text no. 4
    

Top
Correspondence Address:
Youichi Yanagawa
Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Shizuoka
Japan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.145393

Rights and Permissions


    Figures

  [Figure 1]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed2526    
    Printed20    
    Emailed0    
    PDF Downloaded15    
    Comments [Add]    

Recommend this journal