Should an emergency physician be a “surgeon” in a rural area? A case of blunt cardiac rupture successfully treated by an emergency physician

Keisuke KUBO; Tomohiro ABE; Hideki NAGOSHI; Hidenobu OCHIAI

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Should an emergency physician be a “surgeon” in a rural area? A case of blunt cardiac rupture successfully treated by an emergency physician

VernacularTitle:Should an emergency physician be a “surgeon” in a rural area? A case of blunt cardiac rupture successfully treated by an emergency physician
Author: Keisuke KUBO ¹ ; Tomohiro ABE ² ; Hideki NAGOSHI ¹ ; Hidenobu OCHIAI ³
Author Information

1. Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Miyazaki, Japan
2. Department of Emergency and Critical Care Medicine, Miyakonojo Medical Association Hospital, Japan
3. Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, USA
Keywords: clinical competence; health care systems; physician’s role; rural hospital; traumatic cardiac rupture
From:Journal of Rural Medicine 2024;19(2):114-118
CountryJapan
Language:English
Abstract: Objective: Blunt cardiac rupture is a life-threatening injury that requires surgical repair by cardiovascular or trauma surgeons. We report a case of blunt cardiac rupture in a rural area in which emergency physicians performed emergency department thoracotomy and surgical repair to save the patient’s life.Patient and Methods: This case involved an 18-year-old female who was injured in a traffic accident and underwent emergency thoracotomy and surgical repair.Results: The patient’s left thorax was deformed, and sonographic assessment revealed pericardial effusion. She experienced cardiopulmonary arrest 13 min after hospital arrival. An emergency physician performed an emergency department thoracotomy. The clots were removed from the surface of the left ventricle, followed by wound compression to control bleeding from the ruptured left ventricular wall. After the recovery of spontaneous circulation, the emergency physician sutured the ruptured heart. The patient survived with good neurological function.Conclusion: In rural areas, blunt cardiac rupture may require emergency department thoracotomy and cardiac repair by emergency physicians. The establishment of educational systems that include continuous education on trauma surgical procedures and consensus guidelines is needed to assist rural emergency physicians in performing surgical procedures.