Pelvic Traumas and Hybrid Emergency Medicine System: Literature Review Based on Two Cases

Abstract

Objective: Bleeding, the most common life-threatening complication of pelvic trauma occurs due to injuries of pelvic arterial and venous structures and bone fractures. The outcomes of patients can be improved by a timely performed angioembolisation (AE). Hybrid Emergency Service System (HERS) has been recently introduced a novel approach which provides trauma resuscitation room equipped with computerized tomography, fluoroscopy, and an operating room, thus effects the outcomes of trauma patients. Cases: We presented two pelvic traumas and in both cases with the most common life-threatening complication was bleeding. In both cases, whole-body computed tomography (WBCT), endovascular procedures (Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), transcatheter arterial embolization (TAE)), and injury control surgery can be simultaneously performed without the need to transport a patient to an operating room which is called HERS resuscitation. Both patients were discharged and remained free of any medical problem at long-term (12 months) follow-up. Conclusion: Considering the recently introduced HERS system in patient management and integrating it into emergency services will be extremely useful in the management of trauma and trauma-induced bleeding.

Keywords

• pelvic trauma
• bleeding
• HERS

Pelvik Travmalar ve Hibrit Acil Tıp Sistemi: İki Olguya Dayalı Literatür Taraması

Abstract

Amaç: Pelvik travmanın en sık görülen, yaşamı tehdit eden komplikasyonu olan kanama, pelvik arteriyel ve venöz yapıların yaralanması ve kemik kırıklarına bağlı olarak ortaya çıkar. Zamanında yapılan anjiyoembolizasyon (AE) ile hastaların sonuçları iyileştirilebilir. Hibrit Acil Servis Sistemi (HERS), bilgisayarlı tomografi, floroskopi ve ameliyathane ile donatılmış travma resüsitasyon odasını sağlayan ve böylece travma hastalarının sonuçlarını etkileyen yeni bir yaklaşımla yakın zamanda tanıtılmıştır. Olgular: Pelvik travması olan iki hasta sunduk ve her iki olguda da en sık görülen yaşamı tehdit eden komplikasyon kanamaydı. Her iki durumda da tüm vücut bilgisayarlı tomografi (BT) taraması, endovasküler işlemler (Aortun Resüsitatif Endovasküler Balon Oklüzyonu (REBOA), Transkateter Arteriyel Embolizasyon (TAE)) ve yaralanma sonrası kontrol cerrahi, hastanın ameliyathaneye nakledilmesine gerek kalmadan, HERS resüsitasyonu adı verilen sistemde eş zamanlı olarak gerçekleştirilebilmektedir. Her iki hasta da sağlıklı olarak taburcu edildi ve uzun dönem (12 ay) takiplerinde herhangi bir tıbbi sorun yaşanmadı. Sonuç: Son dönemde kullanıma sunulan HERS sisteminin hasta yönetiminde dikkate alınması ve acil servislere entegre edilmesi travma ve travmaya bağlı kanamaların yönetiminde son derece faydalı olacaktır.

Keywords

• Pelvik travma
• kanama
• HERS

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