Reassessing the cardiac box

Turkish Journal of …, 2009

BACKGROUND Penetrating cardiac trauma represents an increasingly important form of trauma due to the frequent use of firearms and bombs in civilian violence. We report our experience over the past 16 years with missile-induced cardiac injuries.

Journal of The American College of Surgeons, 1998

Study Design: This is a prospective, 1-year study in a Level I Trauma Center with the objective of analyzing:

Brazilian journal of cardiovascular surgery

Penetrating heart injuries present high mortality rates. Increasing rates of urban violence have contributed to a significant rise in the number of heart injuries by firearm projectiles. Such injuries are associated with the highest mortality rates among penetrating cardiac injuries and may involve one or more cardiac chambers. We present the case of a police officer who, in an approach to five robbers, suffered a transfixed cardiac injury by firearm with the projectile having been lodged inside the right ventricle. This patient was successfully operated, 65 days after the injury, at our institution.

2013

Background: Penetrating cardiac injuries are a dramatic and lethal form of trauma. They are usually sustained by young people. The majority of victims die before reaching the hospital. Aim of the study: The aim of the study was to establish prognostic criteria for the outcome of penetrating cardiac injury. Material and methods: We retrospectively reviewed the records of 186 patients with penetrating cardiac injuries who were operated on during the first 24 hours after admission. Results: The mean age was 33 (interquartile range (IQR): 26-44) years. 88.7% of victims were male. The mean time from the moment of trauma to arrival at the hospital in Vilnius city was 60 minutes (IQR: 50-91), whereas from the Vilnius region it was 240 (IQR: 82-390) minutes. The vast majority of patients (176/186, 94.6%) sustained stab wounds. Hemopericardium or cardiac tamponade (142/186, 76.3%) usually was found at the operation. Right ventricle was the most often injured heart chamber (75/186, 40.3%). As...

IntroductionHeart injury caused by thoracic gunshot wounds (GSW) is especially life-threatening and require prompt diagnosis and treatment. Heart injury is especially life-threatening and requires prompt diagnosis and treatment. During the pre-hospital phase and initial triage in the emergency department (ED), early recognition of a patient with heart GSW is difficult but important. The purpose of this study was to evaluate the predictability of heart injury in patients with chest GSWs. MethodsThe National Trauma Data Bank was queried for patients with chest GSW treated at all US trauma centres from July 1, 2009, to June 30, 2016. Patients with and without heart injuries (ICD-9: 861.00-03, 861.10-13) were compared and analyzed. Multivariate logistic regression was performed to evaluate independent factors of heart injury which could be obtained during the pre-hospital or triage phase only. Step-backward selection was used to establish a model for such patients. We used the receiver ...

INTRAPERICARDIAL VENA CAVA INJURY BY FIREARM PROJECTILE (Atena Editora), 2023

INTRODUCTION: Firearm projectile injuries (PAF) are the cause of thousands of deaths in Brazil every year, being responsible for 75% of homicides that occurred in 2012 in underdeveloped countries in the Americas¹, in Brazil, 30825 homicides were committed by PAF, 1878 in Minas Gerais. Despite observing a drop of approximately 25%. Vascular injuries are the main causes of death in FAP trauma, with a mortality rate of up to 90%2, making timely management in trauma reference centers a challenge. CASE REPORT: Male patient, 17 years old, admitted to ``Hospital João XXIII`` in Belo Horizonte from Rio Piracicaba by helicopter after 12 hours of trauma. In the emergency room, an initial assessment was carried out and the patient was found to be hemodynamically stable. On examination, PAF perforations were observed in the anterior chest wall, in the second parasternal intercostal space on the right and a hole in the seventh right intercostal space in the midclavicular line, a tangential hole in the left hypochondrium, holes in the left arm, right forearm and right leg with open fractures. of the left humerus, right tibia and right ulna. Distal pulses were present and without motor deficits. The chest X-ray showed hypotransparency in the right hemithorax with the presence of two projections in this topography. In FAST, the presence of free fluid (LL) was detected in the four quadrants and a small amount of LL in the pericardial sac. Referred to the surgical center (SC), chest drainage was performed on the right, draining 1.5 L of blood. Xyphopubic midline laparotomy revealed grade III liver injury in segment VIII with active bleeding, tamponade with compresses, pericardial window positive for blood, followed by sternotomy and opening of the pericardial sac, with profuse bleeding from a lesion in the superior vena cava (SVC). Partial clamping of the SVC was performed with Satinsky forceps and the wound was raffiated with 4.0 polypropylene. Then, the mediastinal pleura on the right was opened, revealing a diaphragmatic injury and transfixing injury of the lower lung lobe, without active bleeding, hepatorrhaphy and abdominal drainage after synthesis of the cavities, cleaning and temporary fixation of the bone fractures and sent to the ICU. On the 6th day he developed pericarditis, responding well to clinical treatment, returning to the CC on the 17th day for definitive treatment of the fractures. DISCUSSION: For Naidoo and Hardcastle (2021), injuries in the region of confluence between the right atrium and the SVC are potentially fatal. According to Westphal (2009), the involvement of large vessels is one of the main factors for the lethal outcome after thoracic trauma. The patient remained hemodynamically stable for 12 hours due to the presence of a clot that formed plugging the SVC lesion. Cardiac tamponade did not occur due to communication between the pericardial sac and the pleural space on the right. Hemothorax is justified by both intrapericardial injury and liver injury.

The Journal of Trauma: Injury, Infection, and Critical Care, 2007

Trauma and Emergency Care

Introduction: In Mexico, despite having experience in cardiac trauma (TRACAR), there are few reports. We present the surgical experience of two Trauma Hospitals in Mexico City. Methods: A retrospective analysis of patients with TRACAR treated in Hospital "Balbuena" and "La Villa" was performed between the period from 01 January 2012 to 31 December 2017. Results: 23 patients were included in this study. 13 (56.5%) survivors and 10 (43.5%) non survivors. The ratio male/female was 12/1 vs 9/1, regarding the type of lesion (firearm projectiles, [FP] vs penetrating object, [PO]) and survival, [FP 7 (53.85%) vs PO 6 (46.15%)] vs [FP 8 (80%) vs PO 2 (20%)]. The frequency of wounds was the following: pericardium 9 (28.11%) vs 6 (18.75%), right ventricle 5 (15.63%) vs 6 (18.75%), left ventricle 1 (13.13%) vs 2 (6.25%), right atrium 2 (6.25%) vs 1 (3.13%). Regarding the AAST classification of the frequency was; grade I:6 (46.15%) vs 2(20%), grade II: 4 (30.76%) vs 0, grade III: 3 (23.09%) vs 4 (40%). The utilized surgical approach was left anterolateral : 14 (8[61.54%] vs. 6[60%]); bilateral: 4 (2[15.39%] vs. 2[20%]); sternotomy 3 (1[7.69%] vs. 2[20%]); combined 1 (1 [7.69%] vs. 0); and right 1: (1(7.69%) vs 0). Conclusion: Cardiac trauma is an entity with a high mortality which requires urgent treatment; it currently occurs in younger populations predominantly by firearm projectiles. Our results are consistent with those reported on other series.

Injury, 2001

... The unpaired t-test was used to compare ICU and hospital stay. 3. Results. ... Full-size table (7K). View Within Article. ... 7. TE Madiba and TR Mokoena, Favourable prognosis after surgical drainage of gunshot, stab and blunt trauma of the pancreas. Br. J. Surg. 82 (1995), pp. ...

Journal of Pediatric Surgery, 2000