Emergency mangement of cardiac temponade resulting from blunt trauma

ABSTRACT

A nine year old girl was brought to emergency reception in shock. Her attendant gave history of blunt trauma chest by falling on a pair of scissors while playing with her brother. She was pale, sweating and had cold peripheries. Her pulse was 170 beats per minute with very low volume. Her blood pressure was 40/30 mmHg and JVP was raised. On auscultation her heart sounds were muffled. On local examination, there was a bruise, 1/2 x 2 cm in the fourth intercostal space just lateral to left sternal edge. Her X-Ray chest was non-conclusive and cardiac temponade was diagnosed on echocardiography. Case was shown to cardiac surgeon who with mutual consultation with pediatric cardiologist decided to go for an emergency thoracotomy as they were suspecting big tear or trauma to the big vessel, so it was decided for definitive repair. Intravenous lines maintained and blood arranged. Patient was resuscitated with intravenous fluids, inotropic support and oxygen with face mask in intensive care unit. After about half an hour patient improved slightly and was shifted to operation theatre. Invasive blood pressure monitoring by 22 G intra-arterial cannula in right radial artery was started. After induction with Ketamine and tracheal intubation, central venous lines were established with one double lumen catheter and one 16 G cannula passed in the right internal jugular vein. Mid sternal thoracotomy was performed. It revealed pericardial cavity full of clots and fresh blood. There was an injury mark about 1/4 x 1/2 cm just lateral to left anterior descending artery on right ventricle and blood was spurting from the wound which was stitched. Hemostasis secured and chest closed. She was transfused with two units of blood during the operation. She remained hemodynamically stable afterwards