Systematic Review of Penetrating Cardiac Injury by a Firearm: Forensic Implications

Management of cardiac trauma and penetrating cardiac injuries with severe hemorrhagic shock: a 5-year experience

PURPOSE

The diagnosis and management of cardiac trauma and penetrating cardiac injuries pose significant challenges in emergency settings due to the rapid onset of life-threatening complications. This paper presents a narrative review to better describe the etiology, presentation, and management of penetrating cardiac trauma, offering insights and experiences related to performing emergency surgery for such cases.

METHODS

We compiled cases of traumatic cardiac rupture and penetrating cardiac injuries accompanied by severe hemorrhagic shock that necessitated emergency surgery. Data were collected regarding the type of injury, causative agents, specific clinical features observed during emergency admission, intraoperative parameters, and treatment outcomes.

RESULTS

Twenty-one patients (16 men, 5 women) with cardiac rupture or penetrating cardiac injuries were recorded. All patients presented in severe shock, and six cases (28.6%) experienced cardiac arrest upon arrival in the operating room. Cardiac rupture due to blunt chest trauma occurred in two cases (9.5%), and one case (4.8%) involved right atrial perforation due to complex open chest trauma. Penetrating injuries accounted for cardiac perforation in 18 cases (85.7%). Associated injuries were present in 11 cases (52.4%). The intraoperative mortality rate was 9.5%, and there was one postoperative death on the 11th day due to multiorgan failure.

CONCLUSIONS

Cardiac trauma and penetrating injuries are usually fatal unless promptly diagnosed and surgically treated. The timing and rapidity of emergency surgery-often foregoing ancillary tests and administrative procedures-are critical for patient survival. Emergency sternotomy, swift control of bleeding, and aggressive resuscitation are essential operative measures in saving lives. Factors that influence prognosis include the extent of blood loss, duration of cardiac arrest, acid-base imbalances, coagulopathy, multiorgan failure, and postoperative infections.

Unusual pattern of firearm injury to trunk and limbs: Two case reports and review

This article presents two cases of fatal injuries from rifled weapons with unconventional shapes of inlets and exits mismatched with the distance of firing. According to forensic literature, in long-distance ranges, we expected to see rounded entry wounds smaller than bullet size, circular in shape without associates with limited damage in the tissues. In the first case, there were large wounds which did not match a distance of more than 2 m, while in the second case, the distance was more than 30 m with large wounds 21 × 10 cm and massive damage to bones and lungs. In the first case, a 25-year-old male, he had multiple wounds in the front of the chest, the first one over the sternum end measuring 9 × 7 cm rounded in shape with fracture of the ribs, sternum and lung laceration. The second wound was 3 × 5 cm in the lateral aspect - mid axillary line and it was superficial due to tangential passage of the missile. In the left thigh, two inlets, each approximately 5 × 7 cm, were seen, the first one over the left iliac bone rounded and the second inlet was in the midshaft of the femur. The exit was below the left gluteus, rounded in shape 5 × 7 cm. The second case a 19-year-old male, he showed single oval wound in the middle third of the back, and it measured 21 × 10 cm. The missile passed tangentially and led to broken ribs and the vertebral column with a lung laceration.

Sudden death associated with delayed cardiac rupture: case report and literature review

Cardiac injury plays a critical role in the process of thoracic trauma-related fatal outcomes. Historically, most patients who suffer a cardiac rupture typically die at the scene of occurrence or in the hospital, despite prompt medical intervention. Delayed cardiac rupture, although rare, may occur days after the initial injury and cause sudden unexpected death. Herein, we present the clinical details of a young man who suffered a chest stab injury and recovered well initially, but died days later due to delayed cardiac rupture. The forensic autopsy confirmed delayed cardiac rupture as the cause of death. We also reviewed previous similar reports to provide suggestions in such rare cases in clinical and forensic practice.

Renal injuries in conflict zones: a 6-year study of traumatic cases in Afghanistan

PURPOSE

During hostilities, gunshot wounds are the most common cause of penetrating injuries. In 8-10% of abdominal injuries kidneys are involved. The treatment method include surgical or conservative treatment (fluids + blood components).

METHODS

Of 1266 combat trauma cases treated during 6 to 14 rotation of the Polish Military Contingent in Afghanistan, we extracted a subgroup of 44 kidney injuries. Corelation of trauma mechanism, PATI score, treatment methods, and outcomes was evaluated.

RESULTS

Out of the 41 renal injuries, 20 considered left, 18 right, and 3 both kidneys. There were no statistical significancy in injury lateralization (p = 0.669), and no differences regarding side of a trauma and quantity of blood component used for the treatment (p = 0.246). Nephrectomy was performed on 17 patients (13 left vs. 4 right). A significant correlation between PATI score and the need for a nephrectomy (p = 0.027) was confirmed. Penetrating trauma recquired higher number of blood components comparing to blunt trauma (p < 0.001). The renal salvage rate was in study group was 61.36%. The overall survival (OS) rate was 90.25% - 4 patients died due to trauma.

CONCLUSIONS

The damage side does not result in a statistically significant increase in the need for blood transfusions or differences in the PATI score. The mechanism of trauma does, however, affect the number of blood components required for treatment, particularly in cases of penetrating trauma. With the introduction of proper treatment, the overall survival rate exceeds 90%, even when opting for conservative treatment.