Penetrating injury to the cardiac box and the deadly dozen

Description

A man aged 24 years who was assaulted was brought in by paramedics, boarded and collared, as a trauma notification. On primary survey, the patient was breathing spontaneously, saturating well on a non-rebreather mask. He had equal bilateral breath sounds with stable vital signs. On secondary survey, a 3 cm laceration was noted to the left of the sternal boarder at the fourth ICS. No active bleeding or evidence of sucking wound was evident. FAST examination was equivocal in the trauma bay. After obtaining a chest X-ray to exclude a pneumothorax and widened mediastinum, the patient was taken for a CT scan. Imaging was significant for an anterior 2 cm thick pericardial fluid collection and pneumomediastinum.

An emergent median sternotomy was performed. Access was obtained in the standard fashion, and the pericardium opened. After evacuating the blood and unroofing the haematoma, a 2 cm left ventricular linear full thickness laceration...

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