title: Life-saving treatment by fluid resuscitation and a thoracotomy in a case of deep pulmonary laceration.
abstract: METHODS
  A 41-year-old man survived deep pulmonary and hepatic lacerations by treatment with fluid resuscitation, blood transfusion, thoracotomy, and transcatheter hepatic artery embolization. The patient was transferred to our hospital 46 minutes after his motorbike struck a station wagon from behind. Hemorrhagic shock with systolic blood pressure of 68 mmHg was observed. He showed nonresponse to 20-minute intravenous infusion of 1,500 mL of lactated Ringer's solution. The initial plain chest radiograph showed mediastinal deviation to the left, radio-opacity of the right lower lobe, and decreased radiolucency of the right thorax. Rapid drainage of 800 mL of blood through a right chest tube led to a diagnosis of a deep pulmonary laceration of the right lower lobe. Abdominal computed tomography revealed another deep laceration affecting 40% of the liver. A right lower lobectomy of the lung was performed at 169 minutes after arrival. After the thoracotomy,transcatheter arterial embolization of the right hepatic artery was performed. The patient was discharged on hospital day 57.
  
  
  CONCLUSIONS
  Prompt diagnosis and appropriate treatment are necessary to save patients with multiple, severe blunt injuries. Advanced Trauma Life Support (ATLS) guidelines should be adhered to for appropriate early treatment of patients with severe trauma.
authors.affiliation: Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1143, Japan. nishiumi@is.icc.u-tokai.ac.jp
authors.forename: Noboru
authors.initials: N
authors.lastname: Nishiumi
authors.forename: Haruka
authors.initials: H
authors.lastname: Takeichi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Otsuka
authors.forename: Masayuki
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Sadaki
authors.initials: S
authors.lastname: Inokuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inoue
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001803:Blood Transfusion; D004621:Embolization, Therapeutic; D005440:Fluid Therapy; D006801:Humans; D022125:Lacerations / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008099:Liver / Q000098:blood supply / Q000293:injuries; D055370:Lung Injury / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008297:Male; D009104:Multiple Trauma / Q000150:complications / Q000000981:diagnostic imaging; D011013:Pneumonectomy; D011859:Radiography; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D013908:Thoracotomy; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging