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Penetrating cardiac injury

Bellal Joseph, Kareem Ibraheem, Ansab A Haider, Narong Kulvatunyou, Andrew Tang, Terence O'Keeffe, Zachary M Bauman, Donald J Green, Rifat Latifi, Peter Rhee
BACKGROUND: Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However, with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention such as RT is being discussed. The aim of this study was to identify patients who most likely would have potentially benefited from REBOA use based on autopsy findings. METHODS: We performed a 4-year retrospective review of all RTs performed at our Level I trauma center...
November 2016: Journal of Trauma and Acute Care Surgery
Li-Sheng Hsu, Jen-Te Hsu, Min-Lang Chen, Chien-Lin Liao
BACKGROUND: Epicardial pacing wires (EPWs) are commonly employed for diagnosis and treatment of arrhythmia in the acute phase after cardiac surgery. Although rare, retained EPWs may cause mild-to-catastrophic complications. The present case demonstrates hemopericardium caused by a mobile retained EPW. METHODS: A 49-year-old woman presented to our emergency department with clinical signs of impending cardiac tamponade. She had undergone ventricular septal defect repair 7 years before this admission...
September 2016: Medicine (Baltimore)
Fahad Almehmadi, Mark Chandy, Kim A Connelly, Jeremy Edwards
Delayed cardiac tamponade after a penetrating chest injury is a rare complication. The clinical diagnosis of tamponade is facilitated with imaging. We present a case report of a 23-year-old male who was brought to emergency after multiple stab wounds to the chest. After resuscitation and repair of laceration of right internal mammary artery and right ventricle, he was discharged but later returned with shortness of breath. Echocardiography revealed a rare case of delayed pericardial tamponade causing left ventricular collapse...
2016: Case Reports in Cardiology
Onur Işık, Çağatay Engin, Ahmet Daylan, Cengiz Şahutoğlu
Use of high-velocity air guns can to lead to serious injuries. Management options of cardiac pellet gun injuries are based on patient stability, and course and location of the pellet. Presently reported is the case of a boy who was shot with an air gun pellet. Following right ventricular entry, the pellet lodged in the left atrium and embolized to the right iliac and femoral artery. Following pellet localization, right ventricular injury was repaired, and the pellet was removed successfully.
May 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Manjunath Maruti Pol, K Shiv Krishna Prasad, Vishant Deo, Madhur Uniyal
Penetrating cardiac injury (PCI) is gradually increasing in developing countries owing to large-scale manufacturing of illegal country-made weapons. These injuries are associated with significant morbidity and mortality. Logistically it is difficult to have all organ-based specialists arrive together and attend every critically injured patient round-the-clock in developing countries. It is therefore important for doctors (physicians, surgeons and anaesthetists) to be trained for adequate management of critically injured patients following trauma...
2016: BMJ Case Reports
Yoshimitsu Izawa, Shuji Hishikawa, Tomohiro Muronoi, Keisuke Yamashita, Hiroyuki Maruyama, Masayuki Suzukawa, Alan Kawarai Lefor
BACKGROUND: Live tissue models are considered the most useful simulation for training in the management for hemostasis of penetrating injuries. However, these models are expensive, with limited opportunities for repetitive training. Ex-vivo models using tissue and a fluid pump are less expensive, allow repetitive training and respect ethical principles in animal research. The purpose of this study is to objectively evaluate the effectiveness of ex-vivo training with a pump, compared to live animal model training...
2016: World Journal of Emergency Surgery: WJES
Yuko Ono, Takuya Sugiyama, Yasuyuki Chida, Tetsuya Sato, Hiroaki Kikuchi, Daiji Suzuki, Masakazu Ikeda, Koichi Tanigawa, Kazuaki Shinohara
BACKGROUND: A reduction in medical staff such as occurs in hospitals during nights and weekends (off hours) is associated with a worse outcome in patients with several unanticipated critical conditions. Although difficult airway management (DAM) requires the simultaneous assistance of several appropriately trained medical caregivers, data are scarce regarding the association between off-hour presentation and endotracheal intubation (ETI)-related adverse events, especially in the trauma population...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Dietrich Doll, Markus Eichler, Pantelis Vassiliu, Kenneth Boffard, Tim Pohlemann, Elias Degiannis
BACKGROUND: Penetrating trauma is becoming increasingly common in parts of the world where previously it was rare. At the same time, general surgeons and surgical trainees are becoming more specialized, and less comfortable operating within areas beyond their zone of specialization. OBJECTIVE: The purpose of this manuscript is to assess the technical difficulties encountered in operating on patients who have sustained penetrating trauma, and to prove to general surgeons that the technical skills and techniques required are no different to those required for abdominal surgery, and do not require additional dexterity...
August 23, 2016: World Journal of Surgery
Marco Chiarelli, Martino Gerosa, Angelo Guttadauro, Francesco Gabrielli, Giuseppe Vertemati, Massimo Cazzaniga, Luca Fumagalli, Matilde De Simone, Ugo Cioffi
BACKGROUND: The majority of patients with severe blunt chest trauma is successfully treated with supportive measures and thoracostomy tube; only few cases need urgent thoracotomy. Lung-sparing techniques are treatments of choice but major pulmonary resections are necessary in case of injuries involving hilar vessels or bronchi. Currently the mortality associated with pulmonary lobectomy performed for chest trauma is 40%. METHODS: Over a 2-year period [2013-2014], 210 patients with chest trauma were hospitalized at our Institution...
July 2016: Journal of Thoracic Disease
Jamie E Anderson, Edgardo S Salcedo, Kacie M Rounds, Joseph M Galante
BACKGROUND: In penetrating thoracoabdominal trauma, it is necessary to evaluate both pericardial fluid and the diaphragm directly. Trans-diaphragmatic pericardial windows provide direct access to the pericardium and diaphragm, but expose the patient to the risks of laparotomy. We hypothesize that transabdominal laparoscopic pericardial windows are a safe and effective alternative to trans-diaphragmatic pericardial windows in stable patients. METHODS: This is a retrospective observational study of stable patients with thoracoabdominal penetrating trauma at a Level I Trauma Center between January 2007 - June 2015, comparing outcomes after trans-diaphragmatic (TDW) versus laparoscopic pericardial windows (LPW)...
July 6, 2016: Journal of Trauma and Acute Care Surgery
Bryan C Morse, Michael J Mina, Jacquelyn S Carr, Rashi Jhunjhunwala, Christopher J Dente, John U Zink, Jeffrey M Nicholas, Amy D Wyrzykowski, Jeffrey P Salomone, Gary A Vercruysse, Grace S Rozycki, David V Feliciano
BACKGROUND: This study evaluates patterns of injuries and outcomes from penetrating cardiac injuries (PCIs) at Grady Memorial Hospital, an urban, Level I trauma center in Atlanta, Georgia, over 36 years. METHODS: Patients sustaining PCIs were identified from the Trauma Registry of the American College of Surgeons and the Emory Department of Surgery database; data of patients who died prior to any therapy were excluded. Demographics and outcomes were compared over three time intervals: Period 1 (1975-1985; n = 113), Period 2 (1986-1996; n = 79), and Period 3 (2000-2010; n = 79)...
October 2016: Journal of Trauma and Acute Care Surgery
Sandeep Choudhary, Suresh Pujar Venkateshacharya, Chinnaswamy Reddy
Sewing needles are rare causes of penetrating cardiac injury. Suicidal attempt, accidental penetration, domestic violence, and child abuse are likely causes for such injury. 1 Owing to their sharp nature, needles can rapidly migrate through the tissues. Fatalities are due to cardiac tamponade, infection, peripheral embolism, and valve dysfunction.
October 2016: Cardiology in the Young
Mehreen T Kisat, Asad Latif, Cheryl K Zogg, Elliott R Haut, Syed Nabeel Zafar, Zain G Hashmi, Tolulope A Oyetunji, Edward E Cornwell, Hasnain Zafar, Adil H Haider
BACKGROUND: Prolonged intensive care unit length of stay (ICU-LOS) is associated with high mortality for medical and surgical patients. Existing literature suggests that this may not be true for trauma patients. The objective of this study was to determine mortality associated with varying ICU-LOS among trauma patients and to assess for independent predictors of mortality. METHODS: Adult ICU patients (16-64 years) in the National Trauma Data Bank (2007-2012) were categorized by ICU-LOS: 1, 2-9, 10-40, and >40 days (determined based on inflection points)...
September 2016: Surgery
Viktor Zsolt Kovari
PURPOSE: To detail the management, complications and results of a crossbow arrow injury, where the broadhead went through the mouth, tongue, soft palate, C2 vertebra, spinal canal, dural sack, exiting the neck posteriorly and the arrow shaft lodged in the spine causing mild spinal cord injury. METHODS: Case presentation. RESULTS: A penetrating axial cervical spine crossbow injury was treated successfully in spite of the following interdisciplinary complications: meningitis, cerebrospinal fluid leakage, re-bleeding, and cardiac arrest...
May 26, 2016: European Spine Journal
E W Stranch, B L Zarzaur, S A Savage
INTRODUCTION: Penetrating cardiac injuries are infrequent but highly lethal. To address these injuries, cardiopulmonary bypass and cardiothoracic surgery availability are required for Level I trauma center verification. However, acute care surgeons are more readily available for this time-sensitive injury. The purpose of this study was to review an acute care surgery-based experience with penetrating cardiac trauma at an urban Level 1 trauma center. Our hypothesis was that care provided solely by acute care surgeons was both safe and effective for this patient population...
May 18, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Bellal Joseph, Kareem Ibraheem, Ansab A Haider, Narong Kulvatunyou, Andrew Tang, Terence O'Keeffe, Zachary M Bauman, Donald J Green, Rifat Latifi, Peter Rhee
BACKGROUND: Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However; with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention like RT is being discussed. The aim of this study was to identify patients that most likely would have potentially benefitted from REBOA use based on autopsy findings. METHODS: We performed a four-year retrospective review of all RT performed at our Level I trauma center...
May 18, 2016: Journal of Trauma and Acute Care Surgery
Alexander Levitov, Heidi L Frankel, Michael Blaivas, Andrew W Kirkpatrick, Erik Su, David Evans, Douglas T Summerfield, Anthony Slonim, Raoul Breitkreutz, Susanna Price, Matthew McLaughlin, Paul E Marik, Mahmoud Elbarbary
OBJECTIVE: To establish evidence-based guidelines for the use of bedside cardiac ultrasound, echocardiography, in the ICU and equivalent care sites. METHODS: Grading of Recommendations, Assessment, Development and Evaluation system was used to rank the "levels" of quality of evidence into high (A), moderate (B), or low (C) and to determine the "strength" of recommendations as either strong (strength class 1) or conditional/weak (strength class 2), thus generating six "grades" of recommendations (1A-1B-1C-2A-2B-2C)...
June 2016: Critical Care Medicine
Joshua C Grimm, J Trent Magruder, Mary A Wilson, Mary E Blue, Todd C Crawford, Juan C Troncoso, Fan Zhang, Sujatha Kannan, Christopher M Sciortino, Michael V Johnston, Rangaramanujam M Kannan, William A Baumgartner
BACKGROUND: Neurocognitive dysfunction and injury remain problematic after cardiac procedures requiring hypothermic circulatory arrest (HCA). Due to poor blood-brain barrier penetrance and toxicities associated with systemic drug therapies, clinical success has been elusive. Accordingly, we explored targeted dendrimer (a nanoparticle) drug therapies in our well-established canine model of HCA to characterize the biodistribution and cellular localization of these nanoparticles in areas of known neuronal apoptosis and necrosis...
September 2016: Annals of Thoracic Surgery
Vasu Chirumamilla, Kartik Prabhakaran, Petrone Patrizio, John A Savino, Corrado P Marini, Zobair Zoha
INTRODUCTION: Work site injuries involving high projectile tools such as nail guns can lead to catastrophic injuries. Generally, penetrating cardiac injuries are associated with a high mortality rate. PRESENTATION OF CASE: A construction worker was brought to the emergency room having sustained a nail gun injury to the chest. The patient was hypotensive, tachycardic with prominent jugular venous distention, and had a profound lactic acidosis. Bedside ultrasound confirmed the presence of pericardial fluid...
2016: International Journal of Surgery Case Reports
Gerd Daniel Pust, Nicholas Namias
Resuscitative thoracotomy is often performed on trauma patients with thoracoabdominal penetrating or blunt injuries arriving in cardiac arrest. The goal of this procedure is to immediately restore cardiac output and to control major hemorrhage within the thorax and abdominal cavity. Only surgeons with experience in the management of cardiac and thoracic injuries should perform this procedure.
April 14, 2016: International Journal of Surgery
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