Penetrating Cardiac Trauma

Abstract

In the last three decades, there have been numerous publications on the subject of penetrating cardiac injuries including a number of large series. Controversial issues remain; they relate to the diagnostic procedures that may be indicated and the therapeutic strategy best suited to each patient. These controversies are partly a reflection of differences in personal surgical preferences and logistical organization of trauma care. To a large extent, however, they stem from a lack of consistent stratification of patients. An elaborate scoring system for the purpose of predicting outcome has been devised, but attempts as classifying patients to involve rational management decisions have been rare and incomplete. In our clinical practice, we classify our patients in five categories. Although this classification facilitates diagnosis and therefore management of the patient, the recent advent of e-FAST availability at the emergency department, performed immediately on admission by the emergency physician or trauma surgeon, results in a reliable diagnosis of cardiac tamponade irrespective of the intensity of the clinical findings.