T. Guenoun et al., MANAGEMENT OF PATIENTS WITH SUSPECTED PEN ETRATING CARDIAC INJURY, Annales francaises d'anesthesie et de reanimation, 15(3), 1996, pp. 307-309
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.