Case ConferenceCASE 6---2015: Penetrating Biventricular Cardiac Injury in a Trauma Patient: Heart Versus Machete
Section snippets
Case Report
A 31-year-old man (height 175 cm, weight 77 kg) was brought to the trauma center after sustaining stab wounds with a machete. One wound was to the left shoulder, and a second wound was to the left anterior chest. He arrived without vital signs and receiving cardiopulmonary resuscitation (CPR). The total time without vital signs was reported by prehospital personnel to be<10 minutes. The patient underwent immediate tracheal intubation, intravenous access was obtained, and an anterolateral
Discussion
In the United States, trauma is the third leading cause of death in people of all ages (following heart disease and cancer) and is the leading cause of death in children and adults up to 44 years of age.1 Overall, motor vehicle accidents are the number 1 cause of fatalities owing to injury.1 Firearm-related fatalities are the second leading cause of injury-related deaths. Cardiac injury of varying degrees can be found in many trauma patients, from a small cardiac contusion that is never
Conclusions
Penetrating cardiac injuries can vary greatly on presentation. They can range from small injuries that can close off spontaneously to biventricular rupture. The mechanism of injury, presence and duration of CPR, and signs of life can help determine when extreme lifesaving measures should be initiated. Intraoperative considerations include how and when to induce general anesthesia in these patients. Techniques such as controlled hypotension or temporary asystole can aid in providing a workable
Commentary 1⁎
The resuscitation of a trauma patient begins before arrival at a trauma center. Prehospital care can be as important as what happens after the patient is admitted and can affect outcome just as substantially. Many variables exist outside of the designated trauma center; many are contingent on where the patient is injured. Depending on jurisdiction and local practices, patients may be intubated before arrival, or the prehospital providers may institute mask ventilation in addition to CPR.
Commentary 2†
From a trauma surgery standpoint, penetrating and blunt cardiac injuries are among the most challenging cases to manage clinically and surgically. The case presented by the authors delineates well the various nuances and pitfalls of cardiac trauma management. Until the early 1900s, cardiac injury, especially penetrating injury, was considered fatal.34, 35 At the present time, as a result of significant developments in trauma and emergency medical systems, with training and coordinated
References (48)
The patient with cardiac trauma
J Cardiothorac Vasc Anesth
(2000)- et al.
Is emergency department resuscitative thoracotomy futile care for the critically injured patient requiring prehospital cardiopulmonary resuscitation?
J Am Coll Surg
(2004) - et al.
Survival after emergency department thoracotomy: Review of published data from the past 25 years
J Am Coll Surg
(2000) - et al.
Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock
J Surg
(2011) - et al.
Penetrating wounds of the pericardium and heart
Surg Clin North Am
(1977) - et al.
Penetrating cardiac injuries: A prospective study of variables predicting outcomes
J Am Coll Surg
(1998) - et al.
Trauma epidemiology, mechanisms of injury, and prehospital care
ATLS Subcommittee, American College of Surgeons’ Committee on Trauma, International ATLS working group: Advanced trauma life support (ATLS): The ninth edition
J Trauma Acute Care Surg
(2013)- et al.
Emergency room thoracotomy for penetrating chest injury: Effect of an institutional protocol
J Trauma
(2001) - et al.
Anesthetic considerations for chest trauma
Cardiac and great vessel trauma
Sternotomy or drainage for a hemopericardium after penetrating trauma: A randomized controlled trial
Ann Surg
Update in trauma anesthesiology: Perioperative resuscitation management
Anesth Analg
Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries
N Engl J Med
Hypotensive resuscitation during active hemorrhage: Impact on in-hospital mortality
J Trauma
Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: Preliminary results of a randomized controlled trial
J Trauma
Anesthesia considerations for cardiothoracic trauma
The role of surgeon-performed ultrasound in patients with possible cardiac wounds
Ann Surg
Successful diagnosis of penetrating cardiac injury using surgeon-performed sonography
Ann Thorac Surg
Findings of a randomized controlled trial using limited transthoracic echocardiogram (LTTE) as a hemodynamic monitoring tool in the trauma bay
J Trauma Acute Care Surg
Limited transthoracic echocardiogram: So easy any trauma attending can do it
J Trauma
Surgical repair of right atrial wall rupture after blunt chest trauma
Texas Heart Inst J
Comparison of multiplane transesophageal echocardiography and contrast-enhanced helical CT in the diagnosis of blunt traumatic cardiovascular injuries
Anesthesiology
Use of echocardiography and modalities of patient monitoring of trauma patients
Curr Opin Anaesthesiol
Cited by (1)
Penetrating cardiac injuries: Literature review and analysis of the forensic approach
2022, Frontiers in Bioscience - Landmark