Penetrating Cardiac Injury

Posted by e-Medical PPT Wednesday, August 14, 2013
Penetrating Cardiac Injury
Incidence: 0.16%
Etiology
Gunshot wounds (63%)
Stab wounds (36%)
Impalement
Iatrogenic

Pericardial Tamponade (PT)
Beck’s Triad (10%)
Kussmaul’s sign
Protective effect ?
•Survival: 73% with PT vs. 11% without PT
•Regardless of mechanism

Non-Acute Management
Pericardiocentesis
Pericardial window
Median sternotomy
Thoracotomy

Pericardiocentesis
No role in acute trauma
Removal of 5-10 cc = ↑CO by 25-50%
Not sensitive or specific
•False-negative = 80%
•False-positive = 33%

ED Thoracotomy (EDT)
Thoracotomy performed in ED for pt arriving in extremis
Cardiac tamponade & cardiac hemorrhage
Intrathoracic hemorrhage
Open cardiac massage
Thoracic aortic cross clamping
Evacuate air embolism

Pericardial Window
Hemodynamically “stable”
Types
•Sub-xiphoid
•Intra-peritoneal
Problem:only 18% (+) for blood
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