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Management of a pneumopericardium due to penetrating trauma
- Source :
- Injury. 45:1368-1372
- Publication Year :
- 2014
- Publisher :
- Elsevier BV, 2014.
-
Abstract
- Introduction A pneumopericardium presenting after penetrating chest trauma is a rare event. The surgical management of this clinical problem has not been clearly defined. The aim of this study was to document the mode of presentation and to suggest a protocol for management. Patient and methods A review of a prospectively collected cardiac database of patients presenting to Groote Schuur Hospital Trauma Centre between October 2001 and February 2009 with a pneumopericardium on chest X-ray after penetrating trauma. Results There were 27 patients with a pneumopericardium (mean age 25 years, range 17–36). The mechanism of injury was a stab wound to the chest in 26 patients and a single patient with multiple low velocity gunshot wounds. Six patients (22%) were unstable and required emergency surgery. One of these patients presented with a tension pneumopericardium. Twenty-one patients were initially stable. Two of these (10%) patients later developed a tension pneumopericardium within 24-h and were taken to theatre. The remaining 19 patients were managed with a subxiphoid pericardial window (SPW) at between 24 and 48 h post admission. Ten of these 19 patients (52%) were positive for a haemopericardium. Only 4 of the 19 underwent a sternotomy and only two of these had cardiac injuries that had sealed. There were no deaths in this series. Conclusion Patients with a penetrating chest injury with a pneumopericardium who are unstable require emergency surgery. A delayed tension pneumopericardium developed in 10% of patients who were initially stable. It is our recommendation that all stable patients with a pneumopericardium after penetrating chest trauma should undergo a SPW. A sternotomy is not required in stable patients.
- Subjects :
- Adult
Emergency Medical Services
medicine.medical_specialty
Adolescent
Thoracic Injuries
medicine.medical_treatment
Chest injury
Pneumopericardium
Clinical Protocols
Emergency surgery
medicine
Humans
Trauma centre
Prospective Studies
Stab wound
General Environmental Science
business.industry
Pericardial Window Techniques
medicine.disease
Sternotomy
Pericardial window
Surgery
Treatment Outcome
Practice Guidelines as Topic
General Earth and Planetary Sciences
Presentation (obstetrics)
business
Penetrating trauma
Subjects
Details
- ISSN :
- 00201383
- Volume :
- 45
- Database :
- OpenAIRE
- Journal :
- Injury
- Accession number :
- edsair.doi.dedup.....5252808aa277290cb5e9a7a8fe74a206