Nonlethal Penetrating Cardiac Injury from a Hammer Splinter

Introduction

Based on the patient's vital signs, the presence of cardiac tamponade, and/or hemorragic shock on admission, penetrating cardiac injuries can be divided into four clinical types. In type 1, the pericardial wounds are small and the patients have signs of cardiac tamponade. In type 2, the pericardial wounds are large and the patients may be in severe shock associated with massive hemothorax. Cardiac tamponade and hemorrhagic shock are present concomitantly in type 3. Patients with type 4 injury are rather rare and have neither cardiac tamponade nor hemorrhagic shock, as is the case when cardiac damage is mild with some little bleeding [[1]].

These latter cases can be surprisingly challenging because the paucity of clinical signs and symptoms can delay diagnosis and treatment, with potentially dreadful consequences [[2]].

References

• 1 Gao J, Gao Y, Wei G. et al . Penetrating cardiac wounds: principles for surgical management.  World J Surg. 2004;  28 1025-1029
• 2 Buckman R F, Badellino M M, Mauro L H. et al . Penetrative cardiac wounds: prospective study of factors influencing initial resuscitation.  J Trauma. 1993;  34 717-727
• 3 Mittal V, McAleese P, Young S, Cohen M. Penetrating cardiac injuries.  Am Surg. 1999;  65 444-448
• 4 Madiba T E, Thomson S R, Mdlalose N. Penetrating chest injuries in the firearm era.  Injury. 2001;  32 13-16