medigraphic.com
ISSN 2448-8720 (Print)
Organo Oficial de la Secretaria de Salud de Quintana Roo

2016, Number 34

<< Back Next >>

Salud Quintana Roo 2016; 9 (34)

Penetrating chest wound with injury right atrium and tamponade

Álvarez-Ibarra S, de-Atocha-Rosado-Montero M, Padrón AG

Language: Spanish
References: 18
Page: 16-19
PDF size: 226.80 Kb.


ABSTRACT

Introduction. Penetrating cardiac injuries have increased due to the actual rise in social violence, especially in young people.
Clinical case. Thirty five years-old male who had a dagger like wound in the anterior thorax with 20 minutes of evolution. At his arrival to the emergency room patient is conscious, gibbering, with ethylic breath, pallor of teguments and jugular ingurgitation (elevated jugular venous pressure). The patient presents low blood pressure and muffle heart sounds (Beck´s triad) finding a 2 cm length injury at the third intercostal space and right paraesternal line with active bleeding and air outlet. A pleural probe was placed at emergency department. Vital signs at the admission were: blood pressure (BP) 90/63 mmHg, heart rate (HR) 116 rpm, breathing rate (BR) 18 bpm and temperature 950 F. Laboratory results showed: hemoglobin (Hb) 8.3 g/dL, hematocrit (Ht) 23.7%, glucose 166 mg/dL, normal rest. It has been performed a left anterolateral thoracotomy emergency finding a cardiac tamponade, a 3 x 3 cm pericardial window was developed identifying a right atrium hematoma which is evacuated, observing a 3 cm wall laceration, pericardial patches were placed with simple horizontal mattress sutures with 3-0 prolene.
Discussion. Seventy-five percent of deaths related to trauma are due to the thoracic trauma patients and very few achieve to reach a hospital alive. In the past, the inevitable delay in diagnosis, late transfer to the operating room and physiological deterioration led to unnecessary thoracotomies; currently, with the reversal of these situations, patients now have a better chance of survival.


REFERENCES

  1. Lateef Wani M, Ahangar AG, Nabi Wani S, Irshad I, Ul-Hassan N. Penetrating Cardiac Injury: A Review. Trauma Mon 2012; 17(1):230–232.

  2. Werner OJ, Sohns C, Popov AF, Haskamp J, Schmitto JD. Ludwig Rehn (1849-1930): the German surgeon who performed the worldwide first successful cardiac operation. J Med Biogr 2012; 20(1):32-34.

  3. Harman PK, Trinkle JK, Injure to Hearth. In: Moore EE, Mattox KL, Feliciano DV, editors. Trauma. 2nd ed. Norwalk Appleton & Lange; 1991.

  4. Hill LL. Report a case of successful suture of the hearth. Medical Record 1902; 29:846.

  5. Mataraci I, Polat A, Cevirme D, Büyükbayrak F, Saşmazel A, Tuncer E. et al. Increasing numbers of penetrating cardiac trauma in a new center. Ulus Travma Acil Cerrahi Derg. 2010; 16(1):54-58.

  6. Acuña P. Traumatismo cardíaco penetrante. Nueve años de experiencia en Cancún, Academia Mexicana de Cirugía. Cir Ciruj 2003; 71:23-30.

  7. Fatimi SH, Hanif HM, Awais A, Shamsi G, Muzaffar M. Major thoracic vessels and cardiac trauma: case series from a center in a developing country. Travma Acil Cerrahi Derg 2012; 18 (6):490-494.

  8. Karigyo CJT, Fan OG, Yoshida MM, Menescal RJ, Tarasiewich MJ. Transfixing cardiac injury with perforation in stomach, diaphragm and lung: unusual scenario in penetrating trauma. Rev Bras Cir Cardiovasc 2014; 29(1):103-106.

  9. Khorsandi M, Skouras Ch, Shah R. Is there any role for resuscitative emergency department thoracotomy in blunt trauma? Interact Cardiovasc Thoracic Surg 2013; 16:609-516.

  10. Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N. Survival after emergency department thoracotomy: review of published data from de past 25 years. J Am Coll Surg 2000; 190:288-298.

  11. Hunt PA, Greaves I, Owens WA. Emergency thoracotomy in thoracic trauma- a review. Injury 2006; 37: 1-19.

  12. Working Group, Ad Hoc Subcommittee on outcomes, American College or Surgeons-Committee on trauma. Practique management guidelines for emergence department thoracotomy. J Am Coll Surg 2001; 193:303-309.

  13. Isla-Ortiz D, Esperón-Lorenzana GI, Trejo-Suárez J, Pérez-Palacios R, García- Vega JA, Rodríguez-Benítez F, et al. Trauma penetrante de tórax con lesión cardiaca, manejados mediante toracotomía de urgencia en el Hospital General “Xoco”: reporte de 33 casos. Trauma 2005; 8 (3): 71-75.

  14. Lee TH, Ouellet JF, Cook M, Schreiber MA, Kortbeek JB. Pericardiocentesis in trauma: a systematic review. J Trauma Acute Care Surg 2013; 75(4):543-549.

  15. Rodríguez-Ortega MF, Cárdenas-Martínez G, Vázquez-Minero JC, Gómez- García MA, Vega-Rivera F, Zepeda Sanabria JR, et al. Experiencia en el tratamiento de lesiones de corazón por el cirujano general. Cir Gral 2004; 26(1): 7-12.

  16. Enríquez SG, Fernández CG, Entem FR, San José Garagarza JM, Durán RM. Delayed pericardial tamponade after penetrating chest trauma. Eur J Emerg Med 2005; 12(2):86-88.

  17. Vázquez Minero JC, Ávila Pérez O, Ugalde Loredo JC, Díaz Barrientos C, Ceballos Berruecos R. Dos casos de presentación tardía de lesiones cardíacas. Rev Inst Nal Enf Resp Méx 2008; 21 (2): 114-117.

  18. Vu T, Mazzini FM, Asensio JA. The chase epicardial stabilizer as an adjunct tool for the management of penetrating cardiac injuries. Ann R Col Surg Engl 2012; 94:530-535.




2020     |     www.medigraphic.com