Chai Louis F, Nahass Meghan M, Iacono Stephen A, Grover Karan, Shan Yizhi, Ferraro Joseph, Ikegami Hirohisa, Hanna Joseph S
Rutgers Robert Wood Johnson Medical School, Department of Surgery, New Brunswick, NJ 08901, United States of America.
Rutgers Robert Wood Johnson Medical School, Department of Cardiology, New Brunswick, NJ 08901, United States of America.
Trauma Case Rep. 2023 Aug 21;47:100914. doi: 10.1016/j.tcr.2023.100914. eCollection 2023 Oct.
Penetrating injuries are recognized for the direct tissue damage, which is typically evident on physical examination. Secondary injuries resulting from kinetic energy transfer in the case of gunshot wounds (GSWs), often referred to as "blast injuries", may affect tissues distant to the ballistic trajectory and are often occult. We present a case of delayed cardiac tamponade resulting from secondary blast injury. The patient sustained a thoraco-abdominal GSW with entry adjacent to the cardiac box. An Advanced Trauma Life Support (ATLS)-guided assessment revealed intra-abdominal injuries necessitating operative intervention without evidence of cardiac injury. On post-operative day four, the patient developed chest pain, tachycardia, and shortness of breath. Imaging revealed a large pericardial effusion with cardiac tamponade. Emergent exploration revealed hemopericardium secondary to a bleeding epicardial hematoma without evidence of pericardial violation. Clinicians must maintain a high clinical suspicion for occult, indirect blast injuries which may be life-threatening.
穿透性损伤因其直接的组织损伤而被识别，这种损伤在体格检查时通常很明显。在枪伤（GSW）中，由动能传递导致的继发性损伤，通常被称为“爆炸伤”，可能会影响弹道轨迹以外的组织，且往往难以察觉。我们报告一例由继发性爆炸伤导致的迟发性心脏压塞病例。患者胸腹部遭受枪伤，入口位于心前区附近。在高级创伤生命支持（ATLS）指导下的评估显示存在腹部损伤，需要进行手术干预，但未发现心脏损伤迹象。术后第四天，患者出现胸痛、心动过速和呼吸急促。影像学检查显示大量心包积液并伴有心脏压塞。紧急探查发现心包积血是由心外膜血肿出血所致，未发现心包破裂迹象。临床医生必须对可能危及生命的隐匿性、间接爆炸伤保持高度临床怀疑。
