Bedside Echocardiography in the Management of a Thoracic Stab Wound with Early Pericardial Tamponade
Article first published online: 27 OCT 2008
© 2008 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 15, Issue 12, pages 1322–1323, December 2008
How to Cite
Hart, D., Budhram, G., Reardon, R. and Clinton, J. (2008), Bedside Echocardiography in the Management of a Thoracic Stab Wound with Early Pericardial Tamponade. Academic Emergency Medicine, 15: 1322–1323. doi: 10.1111/j.1553-2712.2008.00270.x
- Issue published online: 3 DEC 2008
- Article first published online: 27 OCT 2008
A 61-year-old male was brought into an urban trauma center with a self-inflicted stab wound to the chest, sustained with a 3-inch pocket knife. Two small left-sided anterior chest wall puncture wounds were present, lateral to the lower sternal border, but medial to the midclavicular line, in the sixth intercostal space.
On arrival, the patient was confused, agitated, and mildly tachycardic. His blood pressure and oxygen saturation were normal. Examination revealed nonlabored breathing with equal breath sounds. Bedside echocardiography by the emergency medicine resident demonstrated a large hemopericardium with clotted blood (Video Clip S1, available as supporting information in the online version of this paper). In the subcostal view, the right ventricle and atrium appear to be collapsing (Figures 1 and 2), and the inferior vena cava (IVC) is distended and noncollapsible with inspiration (Figure 3), indicative of early tamponade. Normal bilateral sliding lung signs and a negative FAST exam indicated lack of pneumothoraces and no immediate intraabdominal hemorrhage. The patient was intubated and rapidly bolused with 2 L of crystalloid. Although ultrasound demonstrated evidence of tamponade, the patient’s vital signs and clinical status appeared momentarily stable, and he was emergently transferred to the operating room for exploration and definitive repair. Vital signs prior to transfer, 9 minutes after arrival, revealed increasing tachycardia with a pulse of 128 beats/min and a blood pressure of 105/83 mm Hg.
In the operating room a pericardial window was attempted, but after encountering pulsatile bleeding and pericardial clot, the procedure was converted to a median sternotomy. A large left ventricular laceration was repaired, and a probable distal left anterior descending (LAD) artery injury was identified. The distal LAD injury was also confirmed by transthoracic echocardiography, which revealed a distal apical wall motion abnormality and a mildly diminished overall ejection fraction. The patient was transferred to the psychiatry service 5 days after arrival and was discharged from the hospital on Hospital Day 11.
Video Clip S1. Large hemopericardium with clotted blood.
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|ACEM_270_sm_VideoClipS1.mov||4584K||Supporting info item|
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