Majeed Zryan Salar, Othman Yad N, Ali Razhan K
Department of Thoracic and Cardiovascular Surgery, Shar Teaching Hospital, As Sulaimaniyah, Iraq.
Shorsh Military Teaching Hospital, As Sulaimaniyah, Iraq.
J Trauma Inj. 2023 Sep;36(3):253-257. doi: 10.20408/jti.2022.0073. Epub 2023 Apr 19.
A century ago, cardiac injuries usually resulted in death. However, despite all the advances in medicine, these injuries still have high mortality and morbidity rates. In the present case, we describe a patient with a bullet injury to the right ventricle who survived at our hospital despite the limitations of our center with regard to modalities and equipment. A 30-year-old man was brought to our emergency department with a bullet wound to his left flank. He was hemodynamically unstable. After only 8 minutes in the hospital and without further investigations he was rushed to the operating room. During laparotomy, a clot was visible in the left diaphragm, which dislodged and caused extensive bleeding. The decision was made to perform a sternotomy in the absence of a sternal saw. An oblique 8-cm injury to the right ventricle was discovered following rapid exploration. It was repaired without the need for cardiopulmonary bypass surgery. After a few days in the hospital, the patient was discharged home. In the event of a penetrating cardiac injury, rapid decision-making is crucial for survival. Whenever possible, the patient should be transferred to the operating room, as emergency department thoracotomies are associated with a high mortality rate.
一个世纪前，心脏损伤通常会导致死亡。然而，尽管医学取得了诸多进展，但这些损伤的死亡率和发病率仍然很高。在本病例中，我们描述了一名右心室枪伤患者，尽管我们中心在治疗手段和设备方面存在局限性，但该患者在我院存活下来。一名30岁男性因左腰部枪伤被送至我院急诊科。他血流动力学不稳定。在入院仅8分钟且未进行进一步检查的情况下，他就被紧急送往手术室。剖腹手术期间，可见左膈肌有一个血凝块，该血凝块脱落并导致大量出血。在没有胸骨锯的情况下决定进行胸骨切开术。快速探查后发现右心室有一处8厘米长的斜形损伤。在无需体外循环手术的情况下对其进行了修复。住院几天后，患者出院回家。对于穿透性心脏损伤，快速决策对生存至关重要。只要有可能，就应将患者转至手术室，因为急诊开胸手术的死亡率很高。
