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Maffione F, Romano L, Di Sibio A, Brandolin D, Schietroma M, Carlei F, Giuliani A. A rare case of cardiac tamponade masquerading as acute abdomen. Int J Surg Case Rep 2020; 77S:S121-S124. [PMID: 32967813 PMCID: PMC7876917 DOI: 10.1016/j.ijscr.2020.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/11/2022] Open
Abstract
Acute abdomen is any acute abdominal condition requiring a quick response. The abdominal discomfort associated with extra-abdominal pathologies could mimic acute abdomen. Cardiac tamponade is a medical emergency. The differential diagnosis could be kept in mind to avoid a delayed treatment.
Introduction Acute abdomen is any acute abdominal condition requiring a quick response. The incidence varies according to age and disease aetiology. The abdominal discomfort associated with extra-abdominal pathophysiology and thoracic conditions could mimic acute abdomen. In this case we report a rare case of a young patient with cardiac tamponade masquerading as acute abdomen. Presentation of case A 25-years-old African man presented to the Emergency Department with abdominal pain. An EKG was performed, which revealed sinus tachycardia, with electrical alternans and borderline reduced voltage. At the time of the admission to our unit, he had a clinical worsening and a CT scan of abdomen was performed, which demonstrated hepatomegaly, abundant pericardial effusion and thin right pleural effusion at the lung bases. An echocardiogram confirmed a circumferential pericardial effusion with initial collapse of the right ventricular free wall. It was decided to immediately transport the patient to the Cardiosurgery Unit of another hospital to undergo pericardiocentesis. Discussion Our experience with this case underlines the important point that patients with a large pericardial effusion may present with the clinical features of acute abdomen and peritonitis. Abdominal pain was the primary symptom that prompted this patient to seek medical attention. Conclusion Acute abdomen is any acute abdominal condition requiring a rapid, often surgical, treatment. Cardiac tamponade is a medical emergency. The differential diagnosis could be kept in mind by any emergency physician, surgeon and anaesthesiologist, because an incorrect diagnosis and therefore an incorrect treatment or a delay in pericardial evacuation can be life-threatening.
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Affiliation(s)
- Francesco Maffione
- Department of General Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Italy
| | - Lucia Romano
- Department of General Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Italy.
| | - Alessandra Di Sibio
- Department of Radiology, S. Salvatore Hospital, Via L. Natali, 1, 67100, L'Aquila, Italy
| | - Denise Brandolin
- Department of General and Emergency Surgery, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Mario Schietroma
- Department of General Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Italy
| | - Francesco Carlei
- Department of General Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Italy
| | - Antonio Giuliani
- Department of General Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Italy
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Yoo B, Shin YC. Cardiac impalement injury by a steel rebar: A case report. Int J Surg Case Rep 2019; 66:174-177. [PMID: 31862661 PMCID: PMC6928328 DOI: 10.1016/j.ijscr.2019.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 12/15/2022] Open
Abstract
Cardiac impalement injuries may be fatal. We report a patient with cardiac injury due to penetration by a steel rebar. The patient also sustained pulmonary injuries. The steel rebar was pulled out gradually during cardiopulmonary bypass (CPB). CPB is an effective surgical treatment even if there is a risk of bleeding.
Introduction Penetrating cardiac injury often occurs in South Korea. However, impalement injury of the heart with other organs is rare and fatal. We present a case of cardiac impalement injury by a steel rebar. Presentation of case A 38-year-old man was brought to the emergency room with a steel rebar of 45.5 cm in length in situ. Chest tomography revealed that the rebar had entered the thorax to the right diaphragm via the left shoulder while piercing the heart. The patient was immediately taken to the operating room for surgery without removing the bar. We were able to rescue the patient with an emergency operation wherein the bleeding site was treated by pulling the steel rebar out step-by-step while performing cardiopulmonary bypass. Discussion Early diagnosis and rapid surgery are important factors for patients with cardiac impalement injury. Haemostasis must be achieved patiently step- by- step without removing the foreign object at once. CPB is an appropriate treatment, even if there is a risk of bleeding. Conclusion This case highlights the importance of immediate surgical treatment for the survival of severe thoracic impalemant injury patients.
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Affiliation(s)
- Byungsu Yoo
- Department of Thoracic and Cardiovascular Surgery, Inje University Ilsan Paik Hospital, Republic of Korea.
| | - Yoon Cheol Shin
- Department of Thoracic and Cardiovascular Surgery, Inje University Ilsan Paik Hospital, Republic of Korea.
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Makey IA, Beers K, Eilers A, Thomas M. Acute serous tamponade after paraesophageal hernia repair reoperation. BMJ Case Rep 2018; 2018:bcr-2018-225466. [PMID: 30093469 DOI: 10.1136/bcr-2018-225466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cardiac tamponade is a common complication after cardiac surgery and is usually caused by bleeding or thrombus in the early postoperative period. Postoperative serous tamponade is more rare and usually of gradual onset. We report an unusual and life-threatening case of serous tamponade occurring on postoperative day 1 following a third-time paraesophageal hernia repair.
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Affiliation(s)
- Ian A Makey
- Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Kevin Beers
- Cardiothoracic Surgery, University of Texas Health, San Antonio, Texas, USA
| | - Amanda Eilers
- Cardiovascular and Thoracic Surgery, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Mathew Thomas
- Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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Li SS, Rossfeld Z, Basu SK. Cardiac Tamponade in a Child With Fever of Unknown Origin. Hosp Pediatr 2017; 7:692-696. [PMID: 29089379 DOI: 10.1542/hpeds.2017-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Susan S Li
- Department of Pediatrics and
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Zachary Rossfeld
- Department of Pediatrics and
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Sanmit K Basu
- Department of Pediatrics and
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio; and
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Abou-Leila A, Voronov G. The Journey of Harmless Bullet: The Perioperative Care of Penetrating Cardiac Injury. Anesth Essays Res 2017; 11:790-793. [PMID: 28928592 PMCID: PMC5594811 DOI: 10.4103/0259-1162.194578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Traumatic injuries to the heart contribute significantly to trauma are associated with high mortality. Cardiac gunshot wounds (GSW) are considered more lethal compared to other injuries and present several unique challenges to the anesthesia management and perioperative care. We are reporting a rare case of a trauma victim who survived a GSW to the heart. We will discuss the perioperative care of penetrating cardiac injuries, the role of the anesthesia team in resuscitation, safe anesthesia induction, cardiopulmonary bypass management, and the essential role of intraoperative transesophageal echocardiogram imaging.
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Affiliation(s)
- Ahmad Abou-Leila
- Department of Anesthesiology and Pain Management, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Gennadiy Voronov
- Department of Anesthesiology and Pain Management, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
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Abstract
PURPOSE Traumatic cardiac injury (TCI) is a challenge for trauma surgeons as it provides a short thera- peutic window and the management is often dictated by the underlying mechanism and hemodynamic status. The current study is to evaluate the factors influencing the outcome of TCI. METHODS Prospectively maintained database of TCI cases admitted at a Level-1 trauma center from July 2008 to June 2013 was retrospectively analyzed. Hospital records were reviewed and statistical analysis was performed using the SPSS version 15. RESULTS Out of 21 cases of TCI, 6 (28.6%) had isolated and 15 (71.4%) had associated injuries. Ratio be- tween blunt and penetrating injuries was 2:1 with male preponderance. Mean ISS was 31.95. Thirteen patients (62%) presented with features suggestive of shock. Cardiac tamponade was present in 12 (57%) cases and pericardiocentesis was done in only 6 cases of them. Overall 19 patients underwent surgery. Perioperatively 8 (38.1%) patients developed cardiac arrest and 7 developed cardiac arrhythmia. Overall survival rate was 71.4%. Mortality was related to cardiac arrest (p = 0.014), arrhythmia (p = 0.014), and hemorrhagic shock (p =0.04). The diagnostic accuracy of focused assessment by sonography in trauma (FAST) was 95.24%. CONCLUSION High index of clinical suspicion based on the mechanism of injury, meticulous examination by FAST and early intervention could improve the overall outcome.
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Barmparas G, Ko A, Harada MY, Zaw AA, Murry JS, Smith EJT, Ashrafian S, Sun BJ, Ley EJ. Decreasing maintenance fluids in normotensive trauma patients may reduce intensive care unit stay and ventilator days. J Crit Care 2015; 31:201-5. [PMID: 26643858 DOI: 10.1016/j.jcrc.2015.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/22/2015] [Accepted: 09/05/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study is to determine if excessive fluid administration is associated with a prolonged hospital course and worse outcomes. MATERIALS AND METHODS In July 2013, all normotensive trauma patients admitted to the surgical intensive care unit (ICU) were administered crystalloids at 30 mL/h ("to keep open [TKO]") and were compared to patients admitted during the preceding 6 months who were placed on a rate between 125 mL/h to 150 mL/h (non-TKO). The primary outcomes were ICU, hospital, and ventilator days. RESULTS A total of 101 trauma patients met inclusion criteria: 56 (55.4%) in the TKO and 45 (44.6%) in the non-TKO group. Overall, the 2 groups were similar in regard to age, Injury Severity Score, Acute Physiology and Chronic Health Evaluation IV scores, and the need for mechanical ventilation. TKO had no effect on renal function compared to non-TKO with similarities in maximum hospital creatinine. TKO patients had lower ICU stay (2.7 ± 1.5 vs 4.1 ± 4.6 days; P = .03) and ventilator days (1.4 ± 0.5 vs 5.5 ± 4.8 days; P < .01). CONCLUSIONS A protocol that encourages admission basal fluid rate of TKO or 30 mL/h in normotensive trauma patients is safe, reduces fluid intake, and may be associated with a shorter intensive care unit course and fewer ventilator days.
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Affiliation(s)
- Galinos Barmparas
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Ara Ko
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Megan Y Harada
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Andrea A Zaw
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Jason S Murry
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Eric J T Smith
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Sogol Ashrafian
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Beatrice J Sun
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Eric J Ley
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
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Ahmed A, Harsha TS, Hamza T, Allen A, Mohamed E. Cardiac tamponade masquerading as gastritis: a case report. J Med Case Rep 2014; 8:264. [PMID: 25078658 PMCID: PMC4132358 DOI: 10.1186/1752-1947-8-264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/02/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pericardial effusion and cardiac tamponade can develop in patients with virtually any condition that affects the pericardium. A high index of suspicion with proper diagnostic scheme can lessen the concomitant morbidity and mortality. Although cardiac tamponade mimics many medical conditions, internists and primary care physicians should be aware of the physiological and clinical aspects of the disease spectrum. CASE PRESENTATION A 31-year-old Caucasian man, with no significant past medical history, presented to our emergency room with acute upper abdominal heaviness of 2 hours' duration after drinking excessive amounts of alcohol in a short period of time (binge drinking). The coexistence of recent alcohol binge drinking and nonspecific abdominal complaints usually presume a diagnosis of gastritis in our daily encounters in the absence of hepatic, biliary or pancreatic derangements. We present a case in which the presenting abdominal pain turned out to be related to cardiac tamponade. CONCLUSIONS Cardiac tamponade is a sort of cardiogenic shock and is a medical emergency. Clinicians should understand the cardiac tamponade physiology, especially in cases without large pericardial effusion, and correlate the signs of clinical tamponade together with the echocardiographic findings. Drainage of cardiac tamponade is life-saving. A high index of suspicion with proper diagnostic arcades lessens the concomitant morbidity and mortality.
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Affiliation(s)
- Abuzaid Ahmed
- Creighton University Medical Center, 601 30th street, 5th floor, Omaha, NE 68131, USA.
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Hwang S, Bae JY, Lim TW, Kwak IS, Kim KM. Pericardial tamponade caused by massive fluid resuscitation in a patient with pericardial effusion and end-stage renal disease -A case report-. Korean J Anesthesiol 2013; 65:71-6. [PMID: 23904943 PMCID: PMC3726851 DOI: 10.4097/kjae.2013.65.1.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 08/08/2012] [Accepted: 08/31/2012] [Indexed: 11/10/2022] Open
Abstract
Pericardial tamponade can lead to significant hemodynamic derangement including cardiac arrest. We experienced a case of pericardial tamponade in a patient with end-stage renal disease. Hemodynamic changes occurred by unexpectedly aggravated pericardial effusion during surgery for iatrogenic hemothorax. We quickly administered a large amount of fluids and blood products for massive bleeding and fluid deficit due to hemothorax. Pericardial effusion was worsened by massive fluid resuscitation, and thereby resulted in pericardial tamponade. Hemodynamic parameters improved just after pericardiocentesis, and the patient was transferred to the intensive care unit.
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Affiliation(s)
- Soonjae Hwang
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Seoul, Korea
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Seferović PM, Ristić AD, Maksimović R, Simeunović DS, Milinković I, Seferović Mitrović JP, Kanjuh V, Pankuweit S, Maisch B. Pericardial syndromes: an update after the ESC guidelines 2004. Heart Fail Rev 2012; 18:255-66. [DOI: 10.1007/s10741-012-9335-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Alcott CJ, Howard J, Wong D, Haynes J. Fibrinous pericarditis and cardiac tamponade in a 3-week-old pony foal. EQUINE VET EDUC 2012. [DOI: 10.1111/j.2042-3292.2011.00380.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Carmona P, Mateo E, Casanovas I, Peña JJ, Llagunes J, Aguar F, De Andrés J, Errando C. Management of cardiac tamponade after cardiac surgery. J Cardiothorac Vasc Anesth 2011; 26:302-11. [PMID: 21868250 DOI: 10.1053/j.jvca.2011.06.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Indexed: 01/27/2023]
Affiliation(s)
- Paula Carmona
- Anaesthesia, Critical Care and Pain Medicine Department, Consorcio Hospital General of Valencia, Valencia, Spain.
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Abstract
Hemorrhage remains a major cause of preventable death following both civilian and military trauma. The goals of resuscitation in the face of hemorrhagic shock are restoring end-organ perfusion and maintaining tissue oxygenation while attempting definitive control of bleeding. However, if not performed properly, resuscitation can actually exacerbate cellular injury caused by hemorrhagic shock, and the type of fluid used for resuscitation plays an important role in this injury pattern. This article reviews the historical development and scientific underpinnings of modern resuscitation techniques. We summarized data from a number of studies to illustrate the differential effects of commonly used resuscitation fluids, including isotonic crystalloids, natural and artificial colloids, hypertonic and hyperoncotic solutions, and artificial oxygen carriers, on cellular injury and how these relate to clinical practice. The data reveal that a uniformly safe, effective, and practical resuscitation fluid when blood products are unavailable and direct hemorrhage control is delayed has been elusive. Yet, it is logical to prevent this cellular injury through wiser resuscitation strategies than attempting immunomodulation after the damage has already occurred. Thus, we describe how some novel resuscitation strategies aimed at preventing or ameliorating cellular injury may become clinically available in the future.
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Affiliation(s)
- Heena P Santry
- Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
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Leidel BA, Kanz KG, Kirchhoff C, Bürklein D, Wismüller A, Mutschler W. [Cardiac arrest following blunt chest injury. Emergency thoracotomy without ifs or buts?]. Unfallchirurg 2008; 110:884-90. [PMID: 17909734 DOI: 10.1007/s00113-007-1332-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In German-speaking countries, most serious thoracic injuries are attributable to the impact of blunt force; they are the second most frequent result of injury after head injury in polytrauma patients with multiple injuries. Almost one in every three polytraumatized patients with significant chest injury develops acute lung failure, and one in every four, acute circulatory failure. The acute circulatory arrest following serious chest injury involves a high mortality rate, and in most cases it reflects a tension pneumothorax, cardiac tamponade, or hemorrhagic shock resulting from injury to the heart or one of the large vessels close to it. Brisk drainage of tension pneumothorax and adequate volume restoration are therefore particularly important in resuscitation of multiply traumatized patients, as are rapid resuscitative thoracotomy to allow direct heart massage, drainage of pericardial tamponade, and control of hemorrhage. However the probability of survival described in the literature is very low for patients sustaining severe chest trauma with acute cardiac arrest. The case report presented here describes a female polytrauma patient who suffered an acute cardiac arrest following cardiac tamponade after admission in the emergency department and who survived without neurological deficits after an emergency thoracotomy. Selections from the topical literature can help the treating physician in the emergency department in making decisions on whether an emergency thoracotomy is indicated after a blunt chest injury and on the procedure itself.
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Affiliation(s)
- B A Leidel
- Klinikum der Universität München, Chirurgische Klinik und Poliklinik - Innenstadt, Nussbaumstr. 20, 80336, München, Germany.
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Affiliation(s)
- Michael Fiedler
- Department of Anesthesia, University of Cincinnati Medical Center, OH 45267-0531, USA
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Gao JM, Gao YH, Wei GB, Liu GL, Tian XY, Hu P, Li CH. Penetrating cardiac wounds: principles for surgical management. World J Surg 2004; 28:1025-9. [PMID: 15573259 DOI: 10.1007/s00268-004-7523-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stab wounds are the main type of penetrating cardiac injury in China and they have a fairly good prognosis when the patient receives expeditious and appropriate management. The objective of this study is to present the experience of managing the patients with penetrating cardiac injuries. A retrospective study involving 82 cases with penetrating wounds of the heart in the past 16 years was carried out. Stab wounds accounted for 86.58% of this series (71 of 82 patients). All 82 cases were treated operatively. The amount of preoperative infusion as fluid resuscitation for shock was less than 1,000 ml in 65.85% of the present study. Only in three patients was preoperative pericardiocentesis performed, yielding a false-negative result in one. Six patients sustaining cardiac arrest soon after arrival were subjected to emergency room thoracotomy (ERT), and five of them survived. The overall survival rate was 96.34%. One patient died of exsanguination due to injury of multiple chambers; of the remaining 2 deaths after operation 1 was associated with abdominal injuries and the other with failure of cerebral resuscitation. From the experience reported in this study, early establishment of diagnosis and prompt thoracotomy against time are the fundamental factors affecting the outcome of penetrating cardiac injuries. Preoperative massive transfusion and pericardiocentesis are not advocated.
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Affiliation(s)
- Jin-Mou Gao
- Department of Traumatology, Chongqing Emergency Medical Center, 1 Jiankang Road, 400014, Chongqing, People's Republic of China.
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Affiliation(s)
- Reuven Rabinovici
- Section of Trauma and Surgical Critical Care, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, CT, USA
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Affiliation(s)
- David H Spodick
- Division of Cardiovascular Medicine, Department of Medicine, Saint Vincent Hospital-Worcester Medical Center, Worcester, Mass, USA
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