Penetrating wounds of the heart and great vessels--a new therapeutic approach.
نویسندگان
چکیده
A series of 36 Black and Coloured patients, presenting during a 1-year period with life-endangering intrathoracic trauma secondary to assault, is presented. Penetrating wounds of the heart were documented in 32 of these patients, 6 of whom died almost immediately after having been brought into the Resuscitation Unit of Tygerberg Hospital, Parowvallei, CP. The remaining 26 patients had clinical features of cardiac tamponade and circulatory collapse, and in 4 of these patients an emergency thoracotomy was performed in the Resuscitation Unit as it was considered inadvisable to delay surgery until theatre had been arranged. Three of the latter 4 were discharged home completely recovered. Total peri-operative mortality was 13.3%, most deaths being due to lacerations of the left ventricle. Penetrating wounds of the ventricles accounted for some 85% of the total cardiac lacerations; other lacerations affected the pulmonary artery and its branches, the aorta, left atrium and internal thoracic artery. The incision most frequently employed at surgery was a median sternotomy (53%), followed by left thoracotomy (40%) and right thoracotomy (7%). Pre-operative emergency management based on pathophysiological principles is discussed. The fact that relatively inexperienced surgical registrars performed many of these operations with good results emphasizes the need for the establishment of resuscitation units in more peripheral hospitals where many of these patients could primarily be treated. These units would then be able to manage many of these patients, probably at an earlier stage than if they were referred to a teaching hospital such as Tygerberg.
منابع مشابه
Successful Removal of a Rivet from the Heart of a Boy with Penetrating Cardiac Injury: A case Report and Literature Review
Introduction: Penetrating cardiac injuries generally occur secondary to gunshot or stab wounds and have a high mortality rate. They are rare and often fatal in children. When a foreign object penetrates the myocardium, it is dangerous to remove it, suddenly, and should be removed gradually to prevent excessive bleeding. Case report: We report a case of an unusual penetrating cardiac injury in a...
متن کاملPenetrating wounds of the heart and great vessels. Experience with 24 cases including 3 with intracardiac defects.
Twenty-four cases of penetrating cardiac injuries due to stab wounds, which were seen over a 3-year period, are reviewed. Ten patients were treated by aspiration alone because tamponade was mild, or because they were seen more than 12 hours after injury. One patient with multiple stab wounds in the ventricles and left atrium died during emergency thoracotomy in the admission room. The mortality...
متن کاملStab wounds penetrating the left atrium.
A stab wound penetrating the left atrium (excluding the left auricle) would have to penetrate through other chambers of the heart or through the great arteries at their origin from the heart to reach the left atrium from the front of the chest. Such wounds would be fatal, the patient dying from profuse haemorrhage within a few minutes. A stab wound through the back of the chest could reach the ...
متن کاملنقش توراکوسکوپی در تشخیص آسیب مخفی دیافراگم در ترومای نافذ توراکو-ابدومینال
Background: Penetrating thoracoabdominal stab wounds may cause diaphragmatic and abdominal organ laceration. However, 15-20% of these cases who are stable and managed by conservative treatment might have hidden diaphragmatic injuries, which could ultimately lead to chronic diaphragmatic hernia. Therefore, a safe and exact diagnostic method for the detection of occult diaphragmatic injuries is v...
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ورودعنوان ژورنال:
- South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
دوره 62 10 شماره
صفحات -
تاریخ انتشار 1982