Successful Management of Penetrating Cardiac Injury with Tamponade in a Low Resource Setting: Case Report from Yekatit 12 Hospital Medical College

Abstract

Penetrating cardiac injury refers to traumatic injury to the heart secondary to penetrating action. This includes injury such as stab, gunshot, and accidental impalements. Hemorrhage, cardiac tamponade, and cardiac failure are the three major disoders associated with penetrating cardiac injury. Patients with cardiac injury have varying clinical conditions from hemodynamically stable to cardiac arrest. Due to this presentation the detection and management of cardiac injury is a great challenge. When this injury occurred in a setting where there is no diagnostic imaging, equipment, or cardiac surgeon, it is a nightmare for the emergency physician. Here we will present a 27 year old male who sustained stab injury to his left chest around the pericardial area which resulted in cardiac tamponade. He was managed with emergency thoracotomy with cardiorrhaphy and discharged improved. Although cardiac trauma accounts about only 1% of chest trauma, it is still has increased mortality and morbidity. Emergency thoracotomy, preferable anterolateral approach, should be done once cardiac injury with tamponade is diagnosed if experienced surgeon is available. But in the setting experienced surgeon is not available one should go for pericardiocentesis as stabilization and for possible transportation of the patient to center capable of doing emergency thoracotomy. In conclusion, having high index of suspicion for cardiac injury, timely transportation, and early operative intervention will have good outcome in patient who sustained penetrating cardiac injury with tamponade. And the result of this case report shows the successful management of cardiac injury with tamponade in resource limited settings.