MANAGEMENT OF PATIENTS WITH SUSPECTED PEN ETRATING CARDIAC INJURY

Penetrating cardiac injury has to be ruled out in any patients with pe netrating thoracic injuries, even in those with no alterations in vita l functions. Undelayed echocardiography should be performed to screen for the presence of pericardial effusion. The first case underlines th e risk of cardiac tamponade if the diagnosis is missed. Echocardiograp hy was not performed because no echocardiographist was present at the time, and a high suspicion of a neck vascular injury existed. Sudden d eterioration due to the onset of acute tamponade was only reversed by an immediate pericardiocentesis followed by surgical haemostasis. The second patient, although stable, had a large echographic pericardial e ffusion. Emergent sternotomy revealed a large amount of blood in the p ericardial space and two cardiac wounds with one on a coronary artery. Penetrating wounds in proximity to the heart, even in a stable patien t, require aggressive attempts at ruling out a cardiac injury. Immedia te echocardiography should be systematically performed to screen for p ericardial fluid.