DIAGNOSIS AND TREATMENT OF COMBAT INJURIES OF THE HEART AND GREAT VESSELS. Review

Безродный, Б Г; Dykuha, S.O.; Kolosovich, I. V.

doi:10.32345/2664-4738.2.2020.12

Cited by 3 publications

(2 citation statements)

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“…Pericardial tamponade, hemorrhagic shock, and cardiopulmonary arrest can occur, even in patients that present hemodynamically stable. 3 Focused assessment with sonography for trauma (FAST) is the initial imaging study, which can be performed by the bedside surgeon. Traditionally, FAST that demonstrates fluid within the pericardium mandates sternotomy.…”

Section: Introductionmentioning

confidence: 99%

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Management of Penetrating Cardiac Injuries With Pericardial Window and Drainage in Select Patients

Czarkowski

Byerly

Lenart

et al. 2023

The American Surgeon™

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Background Management of penetrating chest injuries with a positive pericardial window (PW) are presumed cardiac injuries and traditionally result in sternotomy. However, there is some evidence in the literature that select patients can be managed with PW, lavage, and drainage (PWLD). Methods All patients with penetrating chest trauma who underwent PW and/or sternotomy over a 5-year period were identified. Patients were stratified by operative intervention [PW + sternotomy vs PWLD] and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of therapeutic sternotomy. Results Of the 146 patients who underwent PW and/or sternotomy included in the study, 126 patients underwent PW, 39 underwent sternotomy, and 10 underwent PWLD. There was no difference in demographics, LOS, ICU LOS, vent days, or mortality in patients who underwent PW + sternotomy, compared to patients who underwent PWLD. In the PWLD group, one patient returned to the OR for recurrent pericardial effusion and no patients required sternotomy. Multivariable logistic regression identified ISS as an independent predictor of therapeutic sternotomy (OR 1.160; 95% CI 1.006-1.338, P = .0616). Interestingly, positive FAST, significant CT findings, and trajectory were not predictors of therapeutic sternotomy. There were 7 patients with a left hemothorax and negative FAST found to have a positive PW and cardiac injury mandating sternotomy and repair. Conclusion Penetrating cardiac injury can be managed with PWLD in select patients. Positive FAST, significant findings on CT, and trajectory do not mandate sternotomy. A negative FAST in the setting of a hemothorax does not rule out a cardiac injury.

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Section: Introductionmentioning

confidence: 99%

“…Pericardial tamponade, hemorrhagic shock, and cardiopulmonary arrest can occur, even in patients that present hemodynamically stable. 3…”

Section: Introductionmentioning

confidence: 99%

Management of Penetrating Cardiac Injuries With Pericardial Window and Drainage in Select Patients

Czarkowski

Byerly

Lenart

et al. 2023

The American Surgeon™

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Verletzungsmanagement in Krisengebieten

Pavlu,

Bieler,

Hentsch

et al. 2024

OP-Journal

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Der Ukrainekonflikt zeigt erneut und eindrücklich die Grenzen der medizinischen Versorgungsrealität in Krisengebieten. Kennzeichnend sind ein enormes Verwundetenaufkommen, eine überdurchschnittliche Verletzungsschwere und ein immanenter Ressourcenkonflikt. Eine strukturierte Bewältigung des Massenanfalls von Verletzten und ein Beherrschen der Versorgungsgrundsätze der typischen Verletzungsmuster sind unerlässlich. Dieser Artikel beleuchtet kriegstypische Verletzungsmuster und moderne Versorgungskonzepte.

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Diagnosis and Surgical Treatment of a Gunshot Fragment Wound of the Heart with a Threat of Coronary Artery Perforation

Humeniuk,

Kupchynskyi,

Fylypchuk

et al. 2023

ujcvs

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Each case of fragment heart damage is unique and requires careful preparation for surgical intervention. Complexity of such operations is explained by the probability of unwanted complications associated with technical measures and aimed at extracting fragments of the most diverse localization. The aim. To demonstrate the possibilities of effective diagnosis and optimal surgical treatment of a gunshot fragment wound of the heart with the threat of coronary artery perforation. Material and methods. The article presents a case of diagnosis and surgical treatment of a fragment heart damage with intramyocardial damage of the left ventricular wall with localization under the circumflex branch of the left coronary artery with the threat of its perforation. One day has passed since a mine blast injury. Diagnosis was based on the use of contrast enhanced computed tomography (CT) and coronary angiography. Results. During the diagnostic process, the need to use a CT scan with mandatory contrast media arose, which made it possible to confirm the presence of a fragment in the immediate vicinity of the coronary artery. Coronarography provided additional information which revealed contact of the fragment with the coronary artery with the threat of its perforation. Immediate surgery with artificial blood circulation with stepwise application of magnets of increasing power allowed safe removal of the fragment, avoiding damage to the coronary artery. Conclusions. The most accurate topical diagnosis of fragment localization in heart damage requires CT diagnosis with mandatory contrast media and, if possible, with 3D reconstruction, which allows for surgical intervention with a minimal risk of intraoperative complications. Location of the fragments near the coronary vessels may threaten their damaging during removal and requires careful manipulation to prevent injury to the heart vessels. Detection and removal of sharp fragments located near the coronary vessels require stepwise application of magnets of increasing power to bring the fragment to a safe zone with its subsequent extraction.

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DIAGNOSIS AND TREATMENT OF COMBAT INJURIES OF THE HEART AND GREAT VESSELS. Review

Cited by 3 publications

References 0 publications

Management of Penetrating Cardiac Injuries With Pericardial Window and Drainage in Select Patients

Management of Penetrating Cardiac Injuries With Pericardial Window and Drainage in Select Patients

Verletzungsmanagement in Krisengebieten

Diagnosis and Surgical Treatment of a Gunshot Fragment Wound of the Heart with a Threat of Coronary Artery Perforation

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