Andersen Mads Jønsson, De Paoli Frank V, Mærkedahl Rikke, Jepsen Søren Vad, Dalgaard Karoline Skov, Falstie Thomas, Gerstrøm Gustav
Department of Cardiology, Aarhus University Hospital, Denmark.
Department of Cardiology, Herning Hospital, Denmark.
Case Rep Emerg Med. 2019 Jul 2;2019:2895439. doi: 10.1155/2019/2895439. eCollection 2019.
The survival rate of penetrating cardiac trauma is dismal, with only a few patients reaching the hospital with any signs of life. Short transport time and close proximity to the trauma center are positive factors for survival. We report the successful case of a 21-year-old male with penetrating cardiac injury and tension-pneumothorax with long distance to a trauma facility. The patient was stabbed twice in the anterior left side of the thorax. The emergency services found the patient with suspicion of left tension-pneumothorax. Urgent left mini-thoracotomy was established resulting in spontaneous respiration and clinical improvement. Due to rapid clinical deterioration and clinical suspicion of pericardial tamponade, patient was transported to the local regional hospital only minutes away. Echocardiography confirmed tamponade, and urgent ultrasound-guided pericardiocentesis was performed. During the transport blood was intermittently drained from the pericardial sack until arrival at the trauma center where a penetrating injury to the left ventricle was repaired during urgent cardiac surgery. The patient was discharged 8 days after the incident. . Well organized emergency medical transport systems increase the chance of survival in penetrating cardiac injuries. Urgent pericardiocentesis with continuous drainage can help stabilize a patient until arrival at trauma facility.
穿透性心脏创伤的存活率很低，只有少数患者在送达医院时还有生命迹象。较短的转运时间以及距离创伤中心较近是存活的有利因素。我们报告了一例成功救治的病例，患者为一名21岁男性，患有穿透性心脏损伤并伴有张力性气胸，且距离创伤机构较远。患者左前胸被刺两次。急救人员发现患者疑似左张力性气胸。紧急实施左胸小切口手术，患者恢复自主呼吸且临床症状改善。由于临床症状迅速恶化且怀疑有心包填塞，患者被转运至仅几分钟路程外的当地地区医院。超声心动图证实存在心包填塞，遂紧急进行超声引导下心包穿刺术。在转运过程中，心包腔内的血液被间歇性引出，直至抵达创伤中心，随后在紧急心脏手术中对左心室的穿透伤进行了修复。患者在事件发生8天后出院。组织完善的紧急医疗转运系统可增加穿透性心脏损伤患者的存活几率。紧急心包穿刺并持续引流有助于患者在抵达创伤机构前保持稳定。
