scholarly journals The importance of simulation education for the management of traumatic cardiac injuries: a case series

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Takashi Nagata ◽  
Tomohiko Akahoshi ◽  
Michiko Sugino ◽  
Wataru Ishii ◽  
Ryoji Iizuka ◽  
...  
Keyword(s):  
Emergency Room ◽  
Cardiac Tamponade ◽  
Operating Room ◽  
Motor Vehicle ◽  
Prior Experience ◽  
Median Sternotomy ◽  
Case Series ◽  
Cardiac Trauma ◽  
Stab Wounds ◽  
Blunt Cardiac Trauma

Abstract Background The management of cardiac trauma requires rapid intervention in the emergency room, facilitated by a surgeon with prior experience to have good outcomes. Many surgeons have little experience in the requisite procedures. We report here 4 patients who suffered cardiac trauma, and all 4 patients survived with good neurologic outcomes. Case presentations Patient 1 suffered blunt cardiac trauma from a motor vehicle accident and presented in shock. Cardiac tamponade was diagnosed and a cardiac rupture repaired with staples through a median sternotomy after rapid transport to the operating room. Patient 2 suffered blunt cardiac trauma and presented in shock with cardiac tamponade. Operating room median sternotomy allowed extraction of pericardial clot with recovery of physiologic stability. Patient 3 presented with self-inflicted stab wounds to the chest and was unstable. She was brought to the operating room and thoracotomy allowed identification of a left ventricle wound which was repaired with a suture. Patient 4 presented in cardiac arrest with multiple self-inflicted stab wounds to the chest. Emergency room thoracotomy allowed repair of a right ventricle laceration with recovery of vital signs. Conclusions The management of all 4 patients was according to the principles taught in the ATOM course. Three of the 4 surgeons had no prior experience with management of cardiac trauma and credited the good outcomes to taking the ATOM course. These are uncommon injuries and formal training in their management is beneficial to patients.

Abstract 2061: High Velocity Penetrating Thoracic Trauma with Suspected Cardiac Involvement in Combat During Operation Iraqi Freedom

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Francisco Dominguez ◽  
Alec C Beekley ◽  
Linda L Huffer ◽  
Philip J Gentlesk ◽  
Robert E Eckart
Keyword(s):  
Foreign Body ◽  
High Velocity ◽  
Cardiac Involvement ◽  
Motor Vehicle ◽  
Median Sternotomy ◽  
Operation Iraqi Freedom ◽  
Case Series ◽  
Conduction Delay ◽  
Plain Film Radiography ◽  
Iraqi Freedom

Introduction: The most common cardiac injuries in the U.S. are either blunt trauma from motor vehicle accidents, or low-velocity injuries from stabbings. High-velocity injury is less common, and survival to presentation is rare. During military conflict, high-velocity injury, including gunshot wounds (GSW) and fragment injury from improvised explosive devices (IED) are relatively more common. Methods: Retrospective review of cases with high-velocity penetrating injury and suspected myocardial involvement. We sought to describe the role of varying diagnostic modalities during a 6 month period in Baghdad, Iraq at a U.S. Army hospital during Operation Iraqi Freedom. Results: There were 11 cases who survived to admission (GSW in 5, IED in 6). The mean age of the all male cohort was 27 years (range 3 to 54). Eight of the eleven patients (73%) were victims of polytrauma. The entrance involved the right ventricle (n=3), right atrium (n=2), left ventricle (n=1) or mediastinum and pericardial reflections (n=5). Echocardiography was performed in all eleven patients. All patients had preserved or hyperdynamic myocardial contractility. In seven patients, no foreign body was identifiable, in two patients the foreign body was identified as being within the pericardial fat pad. Three patients were identified as having a suspected ventricular septal defect, ranging in size from 2 to 8 mm. The most common ECG abnormality was conduction delay, both atrioventricular block and right bundle branch block. Plain film radiography and CT scanning were routinely performed, but definitive localization was frequently limited by metallic streak artifact. In four patients, the management of the chest injury was non-surgical, and in one patient the treatment was a chest tube only. Four of the patients underwent median sternotomy, one underwent emergent lateral thoracotomy, and one underwent an infra-diaphragmatic approach. Conclusions: While this case series is too small to draw definitive conclusions, it does demonstrate that a multidisciplinary approach to high-velocity injuries with potential for cardiac involvement augments pre-operative assessment for myocardial injury and may allow selective non-operative management.

scholarly journals Comparative outcome analysis of bleb needling of fibrotic blebs in the clinic versus the operating room: a retrospective case series

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vikram Ponnusamy ◽  
Van Nguyen ◽  
Jella A. An
Keyword(s):  
Success Rate ◽  
Operating Room ◽  
Complication Rate ◽  
Primary Outcome ◽  
Case Series ◽  
Outcome Analysis ◽  
Retrospective Case ◽  
Xen Gel Stent ◽  
Retrospective Case Series ◽  
Ab Interno

Abstract Background To compare 6 month outcomes of bleb needling performed in the clinic vs. the operating room (OR) in adult glaucoma patients with failed bleb. Methods A retrospective case series of 47 eyes from 41 glaucoma patients who received needling with mitomycin C (MMC) of scarred bleb from prior bleb-forming procedures in clinic (32 eyes) vs. the OR (15 eyes), including trabeculectomy (14 eyes), ExPress shunt (16 eyes), and ab-interno XEN gel stent (17 eyes). The primary outcome was needling success, defined as IOP ≤ 18 mmHg on 0 glaucoma medications without requiring an additional IOP lowering procedure within 6 months after needling. Results At 6 months, bleb needling success rate was similar when performed in the clinic vs. in the OR (28% vs. 20%, P = 0.54). Success rate was not statistically different in patients with prior trabeculectomy, ExPress shunt, and XEN gel stent (29% vs. 38% vs. 12%, P = 0.26). When comparing clinic vs. the OR needling procedures at 6 months, there was no difference in mean IOP (14.2 vs. 14.9 mmHg, P = 0.73), mean glaucoma medications (1.4 vs. 1.7, P = 0.69), additional IOP-lowering procedure rate (16% vs. 27%, P = 0.37), or complication rate (0% vs. 7%, P = 0.32). Conclusion Bleb needling with MMC in clinic may be a safe and effective way to revise failed bleb after trabeculectomy, ExPress shunt, and XEN gel stent procedures when compared to needling in the OR.

Purulent Pericarditis Due to Paronychia in a 16-Month-Old Child: A Nail-Biting Story

2018 ◽  
Vol 11 (4) ◽  
pp. NP125-NP128
Author(s):  
Neha Bansal ◽  
Henry L. Walters ◽  
Daisuke Kobayashi
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Cardiac Tamponade ◽  
Constrictive Pericarditis ◽  
Median Sternotomy ◽  
Purulent Pericarditis ◽  
Surgical Interventions ◽  
Nail Biting ◽  
Significant Mortality

Purulent pericarditis is a rare infectious disease with significant mortality, even in the modern antibiotic era. The presenting signs can often be subtle and patients can deteriorate rapidly with cardiac tamponade. We report a previously healthy 16-month-old female who developed purulent pericarditis associated with paronychia and sepsis caused by methicillin-sensitive Staphylococcus aureus. In addition to antibiotic treatment, she required emergent pericardiocentesis for cardiac tamponade, followed by two surgical interventions including full median sternotomy incision and partial pericardiectomy. At 4-month follow-up, she did well with no evidence of constrictive pericarditis on echocardiogram.

Blunt Cardiac Trauma and Pericardial Effusion

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ashlee Stutsrim ◽  
Megan Lundy ◽  
Andrew Nunn ◽  
Martin Avery ◽  
Preston Miller ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Trauma ◽  
Blunt Cardiac Trauma
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