Tangential Gunshot Wound to the Chest Causing Venous Air Embolism: A Case Report and Review

Platz, Elke

doi:10.1016/j.jemermed.2008.01.023

Cited by 14 publications

(20 citation statements)

References 22 publications

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“…If there is an anomalous communication between right and left circulation as it occurs in atrial or ventricular septal defect, patent foramen ovale, or arterial venous malformations or fistula for hemodialysis, arterial embolism can occur as a complication of venous embolism [8].…”

Section: Discussionmentioning

confidence: 99%

Fatal Cerebral Gas Embolism after Hemodialysis

Perez¹

2015

JNSK

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Section: Discussionmentioning

confidence: 99%

Fatal Cerebral Gas Embolism after Hemodialysis

Perez¹

2015

JNSK

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“…8 The incidence of systemic air embolism after severe lung trauma is 4 -14% with a mortality rate of 80% after blunt trauma and 48% after penetrating injury. 2 Air embolism to the coronary arteries may result in rapid collapse due to myocardial ischaemia from trapping of gas bubbles within the coronary microvasculature. Even a small amount of gas entering the arterial system can occlude end arteries, with as little as 0.5-1 mL of air injected into the pulmonary vein causing cardiac arrest as a result of coronary air embolism and resultant ischaemia.…”

Section: Discussionmentioning

confidence: 99%

Air embolism: an unusual cause of delayed death following gunshot wound to the chest

Temlett

Byard

2011

Med Sci Law

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A 29-year-old man was shot in the chest twice sustaining extensive contusion of the right lung. He was, however, clinically stable with no major vessel injury or significant blood loss. Unexpected cardiac arrest occurred hours after hospital admission due to left coronary artery air embolism. Lung parenchymal damage from the passage of two projectiles within the chest wall close to the pleural cavity had occurred, with disruption of the capillary-alveolar interface and passage of air into the pulmonary venous circulation. While tangential gunshot wounds to the chest wall may rarely cause air embolism, symptoms are usually immediate. The present case demonstrates, however, that death may occur unexpectedly some time after the initial trauma in an individual who is considered clinically stable.

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“…11.4) [23]. However, this may not be easy because the pulmonary edema that frequently occurs in these patients tempts one to use high airway pressures and PEEP [24]. In the emergency department, resuscitative thoracotomy may be performed and immediate twisting of the lung after division showing the effect of ventilation with low (350 mL) and high (650 mL) tidal volumes on the quantity of gas bubbles in the left cardiac chambers of a trauma patient.…”

Section: Resuscitation Phasementioning

confidence: 99%

“…It can also happen after a penetrating injury without lung involvement; a case report described a venous air embolism after a tangential gunshot wound to the chest [24]. Unlike air embolism after lung injury, which is often associated with severe hemodynamic and oxygenation abnormalities, these injuries are relatively stable and permit less aggressive measures, such as the use of hyperbaric oxygen.…”

Section: Resuscitation Phasementioning

confidence: 99%

“…Unlike air embolism after lung injury, which is often associated with severe hemodynamic and oxygenation abnormalities, these injuries are relatively stable and permit less aggressive measures, such as the use of hyperbaric oxygen. Ground transportation to hyperbaric oxygen treatment facilities is preferred over air transport given the fact that air bubbles enlarge at high altitudes [24].…”

Section: Resuscitation Phasementioning

confidence: 99%

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Thoracic and Abdominal Injuries

Capan

Miller

2014

Anesthesia for Trauma

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Injuries to the thorax and the abdomen-the torso-contribute significantly to trauma-related mortality and morbidity. While the vulnerability of the closely organized vital organs to injury in this region plays an important role in morbidity and mortality, the noncompressible nature of hemorrhage in this area also contributes immensely to otherwise preventable trauma deaths. While it is estimated that one fourth of trauma deaths is secondary to chest trauma alone and claims about 16,000 lives per year [1], hemorrhage in the torso (thorax, abdomen, and pelvis) also results in a mortality of as much as 70-80 % after otherwise survivable noncerebral and noncardiac injuries in both civilian and military populations [2]. The overall mortality from exsanguination, which remains second to central nervous system (CNS) injury as a cause of death, primarily originates from injuries of the thorax, abdomen, and pelvis; there has been a reduction in death from extremity bleeding because of effective control with tourniquets or topical hemostatic agents, but not from torso bleeding. With increasing use of anticoagulant agents for prophylaxis and management of cardio-and cerebrovascular disorders, bleedingrelated mortality from truncal injuries is probably more frequent. For example, the predominant injury site in patients with cardiovascular disease who died after trauma in one study was chest in 15 % and abdomen in 3 % of instances; head and neck was the injury site in 69 % of patients [3].In 2008, of the more than 42 million injuryrelated emergency room visits in the United States only 4 % were due to torso injuries; the corresponding percentages for upper extremity injuries, lower extremity injuries, head and neck injuries, and vertebral injuries were 18 %, 15 %, 14 %, and 5 %, respectively [4]. Other diagnoses such as poisoning, adverse effects, ill-defined conditions, and mental disorders made up the remaining injury-related emergency room admissions [4]. Thus, although torso injuries represent a relatively small percentage of the emergency room load, they appear to cause a greater proportion of morbidity and mortality than other injuries.Up to 80 % of thoracic injuries coexist with other injuries in major trauma patients, but they require major surgery and anesthesia relatively infrequently. Yet undetected, relatively minor thoracic injuries may result in life-threatening events during surgery for associated injuries or intensive care management of the multiple trauma patient. Pneumothorax and hemothorax are perfect examples of this clinical situation. On the other hand, because of their sometimes silent nature, even major thoracic injuries (e.g., esophageal, diaphragmatic, and airway trauma) may be missed if appropriate diagnostic

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Tangential Gunshot Wound to the Chest Causing Venous Air Embolism: A Case Report and Review

Cited by 14 publications

References 22 publications

Fatal Cerebral Gas Embolism after Hemodialysis

Fatal Cerebral Gas Embolism after Hemodialysis

Air embolism: an unusual cause of delayed death following gunshot wound to the chest

Thoracic and Abdominal Injuries

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