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Transmediastinal and transcardiac gunshot wound with hemodynamic stability.

Zarain Obrador L, Al-Lal YM, de Tomás Palacios J, Amunategui Prats I, Turégano Fuentes F - Case Rep Surg (2014)

Bottom Line: The management and prognosis of these patients are determined by the hemodynamic situation upon arrival to the Emergency Department (ED), as well as a prompt surgical repair if needed.Patients with a TGSW have been divided into three groups according to the SBP: group I, with SBP >100 mmHg; group II, with SBP 60-100 mmHg; and group III, with SBP <60 mmHg.The diagnostic workup and management should be tailored accordingly, and several series have confirmed high chances of success with conservative management when these patients are hemodynamically stable.

View Article: PubMed Central - PubMed

Affiliation: Servicio de Cirugía General II, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.

ABSTRACT
Cardiac injuries caused by knives and firearms are slightly increasing in our environment. We report the case of a 43-year-old male patient with a transmediastinal gunshot wound (TGSW) and a through-and-through cardiac wound who was hemodynamically stable upon his admission. He had an entrance wound below the left clavicle, with no exit wound, and decreased breath sounds in the right hemithorax. Chest X-ray showed the bullet in the right hemithorax and large right hemothorax. The ultrasound revealed pericardial effusion, and a chest tube produced 1500 cc. of blood, but he remained hemodynamically stable. Considering these findings, a median sternotomy was carried out, the through-and-through cardiac wounds were suture-repaired, lung laceration was sutured, and a pacemaker was placed in the right ventricle. The patient had uneventful recovery and was discharged home on the twelfth postoperative day. The management and prognosis of these patients are determined by the hemodynamic situation upon arrival to the Emergency Department (ED), as well as a prompt surgical repair if needed. Patients with a TGSW have been divided into three groups according to the SBP: group I, with SBP >100 mmHg; group II, with SBP 60-100 mmHg; and group III, with SBP <60 mmHg. The diagnostic workup and management should be tailored accordingly, and several series have confirmed high chances of success with conservative management when these patients are hemodynamically stable.

No MeSH data available.


Related in: MedlinePlus

GSW to the right ventricle. Chest X-ray showing a bullet in the right hemithorax and a massive right hemothorax.
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fig1: GSW to the right ventricle. Chest X-ray showing a bullet in the right hemithorax and a massive right hemothorax.

Mentions: Upon arrival to our ED, primary and secondary surveys were carried out according to ATLS protocols, showing decreased breath sounds in the right hemithorax, as well as an entrance wound below the left clavicle, with no exit wound. Chest X-ray showed a bullet in the right hemithorax and a large right hemothorax (Figure 1). A chest tube was inserted, draining 1500 cc. of blood. An echocardiogram revealed a pericardial effusion, with normal cardiac motion. Despite his hemodynamic stability, he was taken straight to the operating room (OR).


Transmediastinal and transcardiac gunshot wound with hemodynamic stability.

Zarain Obrador L, Al-Lal YM, de Tomás Palacios J, Amunategui Prats I, Turégano Fuentes F - Case Rep Surg (2014)

GSW to the right ventricle. Chest X-ray showing a bullet in the right hemithorax and a massive right hemothorax.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4150517&req=5

fig1: GSW to the right ventricle. Chest X-ray showing a bullet in the right hemithorax and a massive right hemothorax.
Mentions: Upon arrival to our ED, primary and secondary surveys were carried out according to ATLS protocols, showing decreased breath sounds in the right hemithorax, as well as an entrance wound below the left clavicle, with no exit wound. Chest X-ray showed a bullet in the right hemithorax and a large right hemothorax (Figure 1). A chest tube was inserted, draining 1500 cc. of blood. An echocardiogram revealed a pericardial effusion, with normal cardiac motion. Despite his hemodynamic stability, he was taken straight to the operating room (OR).

Bottom Line: The management and prognosis of these patients are determined by the hemodynamic situation upon arrival to the Emergency Department (ED), as well as a prompt surgical repair if needed.Patients with a TGSW have been divided into three groups according to the SBP: group I, with SBP >100 mmHg; group II, with SBP 60-100 mmHg; and group III, with SBP <60 mmHg.The diagnostic workup and management should be tailored accordingly, and several series have confirmed high chances of success with conservative management when these patients are hemodynamically stable.

View Article: PubMed Central - PubMed

Affiliation: Servicio de Cirugía General II, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.

ABSTRACT
Cardiac injuries caused by knives and firearms are slightly increasing in our environment. We report the case of a 43-year-old male patient with a transmediastinal gunshot wound (TGSW) and a through-and-through cardiac wound who was hemodynamically stable upon his admission. He had an entrance wound below the left clavicle, with no exit wound, and decreased breath sounds in the right hemithorax. Chest X-ray showed the bullet in the right hemithorax and large right hemothorax. The ultrasound revealed pericardial effusion, and a chest tube produced 1500 cc. of blood, but he remained hemodynamically stable. Considering these findings, a median sternotomy was carried out, the through-and-through cardiac wounds were suture-repaired, lung laceration was sutured, and a pacemaker was placed in the right ventricle. The patient had uneventful recovery and was discharged home on the twelfth postoperative day. The management and prognosis of these patients are determined by the hemodynamic situation upon arrival to the Emergency Department (ED), as well as a prompt surgical repair if needed. Patients with a TGSW have been divided into three groups according to the SBP: group I, with SBP >100 mmHg; group II, with SBP 60-100 mmHg; and group III, with SBP <60 mmHg. The diagnostic workup and management should be tailored accordingly, and several series have confirmed high chances of success with conservative management when these patients are hemodynamically stable.

No MeSH data available.


Related in: MedlinePlus