Cardiac tamponade in multiple injuries

Penetrating left ventricular stab wound: a method of control during resuscitation and prior to repair

A 34-year-old man with left ventricular stab wounds, suffered cardiac arrest soon after arriving in the Intensive Care Unit from the Accident and Emergency Department. He had cardiac tamponade without elevation of his central venous pressure; this was because of exsanguination into his left hemithorax. Immediate thoracotomy while still in his bed confirmed tamponade and revealed two large left ventricular stab wounds, one anterior and on posterior; the heart was in ventricular fibrillation. As he had already been anoxic for some time, no effort could be made to repair the stab wounds before resuscitating him. It was necessary to control bleeding from two separate injuries while replacing volume, continuing with intracardiac drugs, internal cardiac massage and internal defibrillation. This was achieved by inserting a Foley catheter into each wound, inflating the balloons, clamping the catheters and having the assistant gently retracting the catheters against each other while the operator continued with the resuscitation. When the circulation was restored, pledgeted horizontal mattress sutures were inserted on either side of each Foley catheter, which was withdrawn immediately before tying the suture. The patient was discharged home 12 days later without any complications.