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Table of Contents
LETTER TO THE EDITOR
Year : 2014  |  Volume : 4  |  Issue : 2  |  Page : 186-187

Traumatic cardiac injury by gun nails


1 Department of Intensive Care, Tias business school, Tilburg University, Tilburg, Netherlands
2 Department of Cardiothoracic Surgery, Amphia Hospital, Breda and Oosterhout, Netherlands
3 Department of Surgery, Amphia Hospital, Breda and Oosterhout, Netherlands

Date of Web Publication9-Jun-2014

Correspondence Address:
Nardo JM van der Meer
Department of Intensive Care, Amphia Hospital, Molengracht 21, 4818 CK Breda
Netherlands
Nardo JM van der Meer
Department of Intensive Care, Amphia Hospital, Molengracht 21, 4818 CK Breda
Netherlands
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.134190

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How to cite this article:
Hulsman N, Hiddema PA, Veen EJ, van der Meer NJ, Hulsman N, Hiddema PA, Veen EJ, van der Meer NJ. Traumatic cardiac injury by gun nails. Int J Crit Illn Inj Sci 2014;4:186-7

How to cite this URL:
Hulsman N, Hiddema PA, Veen EJ, van der Meer NJ, Hulsman N, Hiddema PA, Veen EJ, van der Meer NJ. Traumatic cardiac injury by gun nails. Int J Crit Illn Inj Sci [serial online] 2014 [cited 2019 Nov 17];4:186-7. Available from: http://www.ijciis.org/text.asp?2014/4/2/186/134190

Sir,

A 40-year-old man presented himself at the Emergency Department after being shot five times by a nail-gun during a robbery. Upon arrival at the Emergency Department the patient had an optimal Glasgow Coma Scale score and was in stable hemodynamic and respiratory condition. Chest X-ray [Figure 1] and [Figure 2] showed five corpora aliena perforating the sternum and probably the heart. The ECG showed no abnormalities. Shortly after, the patient's hemodynamic condition deteriorated slowly.
Figure 1: Chest X-ray, PA, showing the position of the gun nails

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Figure 2: Chest X-ray, LAT, showing the position of the gun nails

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Immediate transfer to the operating theatre followed and an emergency thoracotomy was performed, since a cardiac tamponade was suspected.By opening the pericardium an amount of blood was released improving the hemodynamic condition. Exploration showed that the left ventricle was perforated by one nail just next to the Left Anterior Descending coronary artery (LAD) and four nails perforated the right ventricle. The nails were removed one by one and the wounds were sutured. The postoperative period was uncomplicated. On day seven the patient was discharged from the hospital. Shortly after discharge, a coronary angiography was performed and showed no abnormalities or injuries.

Massive blood loss is usually prevented in case of penetrating cardiac trauma, because the solid object seals off the entry wound. [1] These patients have a high incidence (80-90%) in developing a cardiac tamponade. A normal cardiac silhouette on the chest X-ray does not exclude this. Classic symptoms like pulsus paradoxus or inspiratory jugular venous distention (Kussmaul sign) can be present. [2] Cardiac ultrasound may quickly confirm the presence of increased pericardial fluid. [3]

 
   References Top

1.Singh KE, Baum VC. The anesthetic management of cardiovascular trauma. Curr Opin Anaesthesiol 2011;24:98-103.  Back to cited text no. 1
    
2.Baum VC. The Patient with cardiac trauma. J Cardiothorac Vasc Anesth 2000;14:71-81.  Back to cited text no. 2
[PUBMED]    
3.Fitzgerald M, Spencer J, Johnson F, Marasco S, Atkin C, Kossmann T. Definitive management of acute cardiac tamponade secondary to blunt trauma.Emerg Med Australas 2005;17:494-9.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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