Unusual complications of the central venous catheterization in trauma patients

Central venous catheters (CVCs) are commonly used in patients with trauma. The placement and removal of the CVCs can result in various complications regardless of the skill of the professionals. Herein, two cases of rare complications are presented— an inadvertent subclavian artery catheterization and a cerebral air embolism after a CVC removal. Moreover, practical solutions for each complication are provided in detail.

Intestinal obstruction after trauma laparotomy: a rare case due to colon cancer

The causes of intestinal obstruction are diverse with tissue adhesion, incarcerated hernia, and large bowel neoplasm being the most common causes. Cancer is not easy to diagnose in patients with a history of intestinal obstruction after the intraperitoneal operation following blunt trauma. Herein, we report the case of a patient who was diagnosed with colon cancer after undergoing adhesiolysis due to intestinal obstruction.

Transarterial embolization for traumatic splenic injury in a patient with a variant origin of splenic artery from the proper hepatic artery

A 57-year-old male patient was diagnosed with grade 2 spleen laceration and other multiple organ injuries after a rollover car accident. The patient was hemodynamically stable. Thus, transarterial embolization was performed to the splenic artery (SA). In angiography, the patient’s SA arised from a proper hepatic artery. The embolization finished successfully and the patient was discharged from the hospital on day 12 without any complications. Transarterial SA embolization may be feasible in patients who have varying SA origins even though the procedure is technically more challenging and a longer catheter may be needed compared to those of the usual case.

Self-extubation after major trauma: another trauma?

Self-extubation can lead to detrimental outcomes for the patient. Complications that result from self-extubation range from laryngeal injury, respiratory distress, arrhythmia, pneumonia, to even death. With respect to patient safety, not only is prevention of self-extubation one of the most important goals in all intensive care units around the world, but also it is one of the most common mishaps in the area of intensive care. Since self-extubation and consequent re-intubation are unexpected events, they can embarrass the medical staff and negatively affect the treatment choice, and consequently, require other invasive procedures that may not have been necessary. The most important thing for patients exposed to self-extubation is to keep in mind the presence of airway damage, which can be confirmed through our experience as described here, through repeated re-intubations and eventually tracheostomy.

Unpredictable cardiac arrest caused by blunt cardiac injuries with sternum fracture: a case report

Blunt cardiac injury (BCI) is common in road traffic accidents due to high energy injuries to the thorax and its structures, such as the anterior and posterior of the chest wall. The severity of BCI is high enough to cause many on-site deaths. However, patients with BCI may also be asymptomatic and exhibit normal findings; thus, diagnosis can be significantly challenging for many clinicians. Moreover, since BCI can be diagnosed through multiple serial tests, it is very important to always consider the possibility of BCI in high-risk patients . Diagnosis of BCI begins with suspicion of BCI, followed by repeated electrocardiograms, echocardiography, and cardiac biomarkers measurements along with intensive observation.

Isolated acute hemorrhagic cholecystitis in liver cirrhosis after blunt trauma

Isolated acute hemorrhagic cholecystitis (AHC) after blunt trauma is extremely rare. Thus, alcoholic liver cirrhosis can be a risk factor for this type of injury. The use of point-of-care ultrasound as a monitoring tool for suspicious gallbladder injuries facilitates rapid recognition and decision-making. Therefore, laparoscopic cholecystectomy was recommended for treating traumatic AHC in patients with hemodynamically stable liver cirrhosis.

Usefulness of a needleless suture technique for midline laparotomy wound dehiscence: a case report

Surgical wound dehiscence after a laparotomy is a serious complication, and it presents the mechanical wound healing failure of surgical incisions. Since the development of needleless suture techniques, there have been attempts to use a needleless suture for wounds from several surgery types. Recently, many studies have shown that a needleless suture technique leads to good wound healing results. It is rapid, cost effective, can minimize ventilator dependency, and is well tolerated by patients. Here, we report a case of a patient who received a needleless suture technique for midline laparotomy wound dehiscence.

The need for multiple vascular access or preemptive central venous catheterization in patients requiring planned interhospital helicopter transport: a flight doctor’s suggestion

Hemorrhagic shock can develop due to severe bleeding, such as after major trauma, postpartum or gastrointestinal bleeding. At least two peripheral intravenous routes with large-bore catheters are recommended to reverse hemorrhagic shock, and such functional intravenous routes are essential for the proper management of other concurrent diseases as well. Conditions during helicopter transportation are different from those seen in-hospital, and the primary concerns are to maintain aseptic conditions, protect patient’s privacy, and prevent infection risk, especially during pandemics, such as the ongoing COVID-19. Herein, I describe two recent experiences of improper management during helicopter transport due to intravenous line malfunction. Subsequently, based on my experience, I suggest the use of multiple intravenous routes or preemptive central catheterization in patients requiring helicopter transportation.

Active extraperitoneal hematoma in the anterior abdominal wall after blunt injury

A 65-year-old male patient had extraperitoneal hematoma of the anterior abdominal wall after blunt trauma. The patient was treated with conservative management because of stable hemodynamics without deterioration of physical examination and laboratory tests; however, computed tomography revealed active bleeding. In abdominal wall hematoma, physical examination, hemodynamic monitoring, and laboratory tests may be the most important factor in determining a therapeutic plan. Repetitive imaging can be obtained and invasive treatment should be considered if these indices suggest hematoma exacerbation. Patients with abdominal trauma who have altered coagulation status should be carefully monitored for abdominal wall hematoma. Detecting abdominal wall hematoma is important because it may be the clue for potential intra-abdominal organ injury or delayed complication.

Incidental appendicitis in a blunt trauma patient: a case report

Acute appendicitis is a relatively common disease, but it is rarely caused by trauma. There are some reports on appendicitis caused by blunt abdominal trauma, but the pathophysiology is still uncertain. In this report, we presented a case of a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident.