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Cardiac Surgery 

Lec: 4 

Cardiac Trauma 

May be either :- 

 1.Blunt Trauma 

 2.Pentrating Trauma:- Which is either due to:    

    a.Stab wound              b.gun shot          c.iatrogenic e.g by chest tube. 

Clinical Presentation  depends on: 
 1.Site of injury           2.mode of injury                  3.associated injuries 
      The Right ventricle is mostly involved by penetrating injuries in 42% of  
cases because it occupies the largest percent of the anterior surface area 
of heart followed by Left ventricle in 32%  of cases and Right atrium in 15% 
of cases, Factor  affect  Mortality from penetrating injuries may  be due to 
  1.Coronary artery injury         
   2.multiple chamber injury                
  3.Isolated left side injury 
  4.commonuted tear of single chamber              
  5.Isolated right side chamber injury 
 6. Tangential injury which does not penetrate the endocardium 

  Clinical Presentation

 

A.Temponade:- occur in 80% of cases of stab wound injuries and 20% of 
gunshot injuries. 
B.Haemorrhagic shock occurs in 20% of stab wound injuries and 80% of 
gunshot injuries. 

     

Cardiac Temponad:- 

Occur due to small tears in the pericardium and myocardium, here little or 
transient haemorrhage will be sealed by contraction of myocardial 
muscles, the collection of 100-150 ml. Of blood inside the pericardium will 
press on the heart and leads to classical signs of Becks Tried which are: 
1. Hypotention      2.Distended neck veins       3.Muffled heart sounds 
Other features may be present like tachycardia, shortness of breath, 
pulses paradoxus. 
 


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Haemorrhagic shock:- 

 Occurs due to large tear in the heart and pericardium which leads to:- 
1. Sever bleeding 2.sever hypotension and bradycardia   3.flat neck veins 
4.high mortality 

   Investigations:-  

1. Chest Film:- In temponade is of no benefit as it is an acute event there is 

no enough time for pericardium to distend; while in haemorrhagic 
shock we may see haziness and irregularity of cardiac boarder but the 
patient may not live long enough to do chest film 

2. Echo: - requires cooperative patient and well trained personal and 

associated with 5% false negative rate. 

3. Pericardiocentesis :- must be done with great care and better to be 

guided by echo  and patient must afford pain ; in 15% of cases the blood 
may be clotted. 

4. Subxyphoid pericardial window:- can be done under local anaesthesia  

and when blood found it is evacuated easily and the incision can be 
converted to median sternotomy  to repair the cardiac injury. 

 

   Management :-  
1.

 Secure the air ways, if the patient is not breathing spontaneously  

endotracheal tube must be inserted and oxygen must be delivered by 
umbo back or ventilator.

 

2.  Establish  2 or 3 I.V lines to deliver crystalloid and/ or colloid, in 
Temponade this is of diagnostic value since it improve general condition of 
the patient transiently. 
3. Emergency room operation is indicated in the following condition  

a.  Low Blood Pressure or Agonal breathing.     
b.  b. Rapid deterioration. 
c.  Patient can not be stabilized by usual resuscitative measures. 
d. Strong suspect of cardiac injury. 

The operation is carried out either by Median Sternotomy or Left Anterior 
Thoracotomy. 
 

  


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 Methods of repair of cardiac injury. 

 1.Atrial injury: put a side clamp and suture the tear. 
2.Large vessel injury : repaired like atrial injury.  
3. Small hole in the ventricle :suture with pledgete 
4. injury beside coronary artery: suture with pledgete beneath the 
coronary artery 
5.Coronary artery injury: if small ligate the artery ,if large ligate and do 
coronary bypass graft. 
6.Intracardiac injury: can be manged later on unless it is sever. 
 

Blunt Cardiac Trauma:-

Usually produce cardiac contusion which 

may produce heart block, arrhythmia and decrease contractility 
sometimes damage to atrial septum or ventricular septum may occur or 
damage to valve may occur.

 

 Investigation :- 

1.Cardiac enzmes usually elevated 
2. ECG shows rhythm disturbance 
3.Echo showsabnormal contractility 
Management :- 

1. Simple injury usually self limited and improve spontenously. 
2. Sever injuryleads to poor out comelike cardiac arrest. 

 

Cardiopulmonary resuscitation:-

Measures done to manage 

person sustain cardiopulmonary arrest.cardiac arrest may be due to      
arrhythmia which may be due to  

 

 a. Coronary artery diseases            b. Anoxia           C.electrolyte disturbance             
d. Drug toxicity. 
  Diagnosis is done by confirmation of 
  1.unconsciousness    
2.abscence of central pulse and breathing for 15 seconds 
 Cardiac arrest leads to hypoxia and anerobic metabolism 
Management:-  
1.Secure air ways and breathing. 
2. establish I.V lines 


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3.Cardiac massage  either closed chest massage or open cardiac massage. 
4. ECG monitoring 
5. drugs like adrenaline, xylocain, NaHCO3, insulin+glucose for 
hyperkalemia 
6.  Temporary transvenous or extracardiac  pacemaker. 




رفعت المحاضرة من قبل: Ahmed 95
المشاهدات: لقد قام 16 عضواً و 167 زائراً بقراءة هذه المحاضرة








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