Penetrating cardiac injury

Outlined some of penetrating cardiac injury hospitalization chest trauma of the total 2.8% ~ 12%, heart of the site can be injured. However, the injury rate and heart cavity previous exposure of the chest wall. Penetrating cardiac injuries in hospital mortality in the past gunshot wounds to 60%, stabbed to 15%. Cause pathogenesis for gunshot wounds, shrapnel injuries or knives, scissors and other sharp weapons. There are also diagnostic and interventional treatment arising from the operation of iatrogenic injury. Clinical manifestations of penetrating cardiac injury of pathology and clinical manifestations, on the one hand, depends on the mechanism, that is the nature of penetrating objects, Size and speed. For example, the gunshot wounds were caused by more than 80% of the scene of death and stabbed about 50% still get to the hospital; The other hand, Damage mainly depends on the location, the size of the wound and laceration of the pericardium. Pericardial gap large enough, the major clinical manifestations of hemorrhagic shock, and even rapid death. Pericardial small gap, or surrounding tissues (such as the pericardium fat, lung, etc.) or clots and blockage, Bleeding heart may cause acute cardiac tamponade, diastolic heart is restricted, vena cava upon reflection blocked blood flow and cardiac output decrease. Gunshot wounds caused by the large pericardial gap is reflected mainly in hemorrhagic shock and stabbed the pericardial easily plug the gap, 80% ~ 90% occurred pericardial tamponade. Pericardial tamponade helps to reduce the bleeding heart, the patient survival chances than the bleeding but unmotivated packet packing for the moment, however, if not promptly removed and then quickly lead to circulatory failure. When the heart wound is self-hour closure and stop bleeding. Diagnostic X-ray examination of penetrating cardiac injuries are not very helpful in the diagnosis, but the chest can show that the availability of hemothorax, pneumothorax, metallic foreign bodies or other organs are damaged. Echocardiography of the heart and cardiac tamponade foreign body more help in the diagnosis and can estimate the plot pericardial fluid. Sent to the emergency room treatment of the wounded penetrating cardiac injury can be divided into four categories : ① death : hospital without vital signs before; ② clinically dead : was rushed to the hospital but signs of life, and when no vital signs, ③ dying : semi-conscious, small veins, Measuring less than blood pressure, breathing and sighing, ④ severe shock : systolic blood pressure less than 10.7 kPa (80mmHg). Shang Qing consciousness. These four categories of penetrating cardiac injuries were wounded save the first category is not alive, and the second, three thoracotomy immediate recovery. The fourth category Rethoracotomy first expansion, if the situation does not improve must immediately cardigans recovery. First aid and recovery measures including : ① rapid endotracheal intubation and mechanical ventilation; ② establishing a large-caliber vein rapid expansion of access rapid intravenous rehydration improve blood transfusion heart filling pressure; ③ addition to establishing a central venous pressure measurement device; ④ If hemopneumothorax. be closed drainage; ⑤ suspected pericardial tamponade immediate pericardiocentesis, diagnosis and decompression; ⑥ pericardiocentesis if not out of blood, clinical highly suspected pericardial tamponade, Emergency can be carried out under local anesthesia in the pericardial window exploration exploration pericardial cavity, Add decompression drainage tube. ⑦ have asystole firms will be required surgical recovery, external chest compression is not only ineffective and can increase bleeding and cardiac tamponade. Penetrating cardiac injury should be surgical repair. Preoperative preparation for rapid transfusion mainly suitable amount of dopamine and isoproterenol to increase cardiac contractility. Piercing the heart and remain in the chest wall injury (such as a knife) in the thoracic surgery before removal is not appropriate. ECG and enhance postoperative hemodynamic monitoring, follow-up treatment and recovery. To observe the availability of secondary hemorrhage, residual disease and complications. Conventional given tetanus antitoxin and antibiotics (Cefetaxime acridine, cefazolin V, ofloxacin, metronidazole).