DOI: 10.36347/sjmcr.2017.v05i10.014

Pages: 648-651

A 56-year-old man on a motorcycle ran into a car that had swerved into the oncoming traffic lane in order to pass another car on a mountain path in the Izu peninsula. He was evacuated by a physician-staffed helicopter. On arrival, as he had severe hemorrhagic hypotension, he received urgent transfusions, tracheal intubation and cannulation into the femoral artery for trans-arterial embolization. Whole-body computed tomography (CT) revealed multiple injuries, including unstable thoracic cage and pelvic fracture. Extravasation of contrast medium was observed just at the retroperitoneal space at the pelvis. Urgent trans-arterial embolization for unstable pelvic fracture was executed, followed by external fixation for the fractures. After obtaining stable circulation and respiration by intensive care, he underwent stabilization of thoracic spine and internal fixation for his unstable pelvic fracture separately. Finally, he was transferred to his local medical facility for rehabilitation. This is the first case of the successful recovery a patient who had multiple lethal injuries, including a combination of unstable thoracic cage and pelvic fracture. A multidisciplinary approach, including resuscitation based on the polytrauma guideline and a hospital-tailored treatment protocol, and team dynamics conducted by trained emergency physicians were key to obtaining a survival discharge.