Penetrating cardiac injury: Difference between revisions

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==Background==
==Background==
 
*Ventricles are at greatest risk due to anterior location
**RV (involved in 40% of injuries)
**LV (involved in 35% of injuries)
**RA (involved in 20% of injuries)
**LA (involved in 5% of injuries)


==Clinical Features==
==Clinical Features==
===Penetrating Trauma===
*Location
*Location
**Stab wounds
**Stab wounds
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****Chest area bounded by sternal notch, xiphoid, and nipple
****Chest area bounded by sternal notch, xiphoid, and nipple
**GSW can affect heart even if enters at distant site
**GSW can affect heart even if enters at distant site
*Ventricles are at greatest risk due to anterior location
**RV (involved in 40% of injuries)
**LV (involved in 35% of injuries)
**RA (involved in 20% of injuries)
**LA (involved in 5% of injuries)
*[[Cardiac tamponade]]
**Most often results from stab wounds; up to 80% of myocardial stab wounds may develop cardiac tamponade
**GSW less likely to develop into tamponade because it is more difficult for the pericardium to seal the defect (larger, more irregular in shape) <ref>Tintinalli's</ref>
*Cardiac missiles
**Those that cause BP instability, free or partially exposed should be removed
**Most intramyocardial and intrapericadrial bullets can be left in place


==Differential Diagnosis==
==Differential Diagnosis==
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*[[Thoracotomy]]
*[[Thoracotomy]]
*[[Pericardiocentesis]]
*[[Pericardiocentesis]]
===[[Cardiac tamponade]]===
*Most often results from stab wounds; up to 80% of myocardial stab wounds may develop cardiac tamponade
*GSW less likely to develop into tamponade because it is more difficult for the pericardium to seal the defect (larger, more irregular in shape) <ref>Tintinalli's</ref>
===Cardiac missiles===
*Those that cause BP instability, free or partially exposed should be removed
*Most intramyocardial and intrapericadrial bullets can be left in place


==Disposition==
==Disposition==

Revision as of 20:01, 17 August 2019

Background

  • Ventricles are at greatest risk due to anterior location
    • RV (involved in 40% of injuries)
    • LV (involved in 35% of injuries)
    • RA (involved in 20% of injuries)
    • LA (involved in 5% of injuries)

Clinical Features

  • Location
    • Stab wounds
      • Usually affect heart if enter via the "cardiac box"
        • Chest area bounded by sternal notch, xiphoid, and nipple
    • GSW can affect heart even if enters at distant site

Differential Diagnosis

Thoracic Trauma

Evaluation

Workup

  • FAST exam
    • First view of FAST in penetrating injury should be pericardial
    • Pericardial fluid detection (Sn 100%, Sp 97%)
  • CTA
    • Imaging study of choice for penetrating and blunt trauma

Management

Cardiac tamponade

  • Most often results from stab wounds; up to 80% of myocardial stab wounds may develop cardiac tamponade
  • GSW less likely to develop into tamponade because it is more difficult for the pericardium to seal the defect (larger, more irregular in shape) [1]

Cardiac missiles

  • Those that cause BP instability, free or partially exposed should be removed
  • Most intramyocardial and intrapericadrial bullets can be left in place

Disposition

  • Admit

See Also

References

  1. ↑ Tintinalli's
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