The victim of thoracic gunshot: Assessment of the patient and management of pulmonary artery bullet embolism

Reply to the Editor

“…Therefore, no attempt should be made to extract the bullet during an emergency operation in a patient whose condition is unstable. 4 If one decides to reoperate on the patient to extract the projectile, this second look operation must take into account the risks of the surgery when the patient is asymptomatic.…”

Decision changing in the operating room: The importance of the surgeon′s certainty and a well prepared team

“…In the case of intense adherences, an extrapleural technique can be executed; moreover, in these cases, the mediastinal pleura is usually not too adherent, so intrapericardial vessel ligation may be done without the need for a median sternotomy. [8] Authors also wonder if internal mammary artery ligation could help stop bleeding. As intercostal arteries are direct branches from thoracic aorta, this ligation would have minimal if some, effect in diminishing the “massive bleeding” reported.…”