A Case of Pericardial Tamponade Caused by Abdominal Knife Stab Injury
A B S T R A C T
This paper reported a case of pericardial tamponade, caused by the blood from abdominal organ injury, which flowed through the diaphragm and pericardial holes into the pericardium. Liver injury, gastric injury, pancreatic injury, diaphragmatic break were found by the following laparotomy exploration.
Keywords
Pericardial tamponade, hemorrhagic shock, abdominal stab injury
Case Report
A male, 41-year-old patient with emergency pericardial tamponade and abdominal knife stab wound, was admitted into the operation room for open chest and abdominal exploration. The patient showed symptoms of lip cyanosis, shortness of breath, with a blood pressure of 120/85mmHg, heart rate of 132 beats/min, oxygen saturation of 92%. The patient kept a half-sitting posture and a condition of a full stomach. The patient was performed left radial artery and right internal jugular vein puncture anaesthetized with lidocaine. Blood gas analysis showed pH: 7.31, PaCO2: 37 mmHg, PaO2: 199 mmHg, BE: -7.7, HCT: 34%. Tracheal intubation was performed with fast induction (midazolam 4 mg, cisatracurium 0.2 mg/Kg, sufentanil 40 µg, propofol 1 mg/Kg) after rapid acidosis correction and volume expansion. Pericardium diaphragmatic surface break and no damage to the heart was observed by median emergency thoracotomy exploration.
The pericardial hemorrhage was originated from abdominal organ injury. The chest was closed after cleaning up the pericardial hemorrhage, repairing the pericardium and chest exploration; no other organs in the chest was injured. Liver injury, gastric injury, pancreatic injury, diaphragmatic break were found by the following laparotomy exploration, then gastric partial resection and repair, liver rupture repair, pancreatic tail repair and diaphragm repair were performed. Pericardial tamponade was caused by the blood from abdominal organ injury, which flowed through the diaphragm and pericardial holes into the pericardium. The operation lasted 5.5 h with 4000 ml intraoperative bleeding, a total of 10 unit red blood cells and 1000 ml fresh frozen plasma were transfused during the operation, the patient returned to the ICU after the operation.
Discussion
The key to anaesthesia management of the patients was the following: firstly, the conventional treatment of full stomach, inhibition of gastric acid secretion, gastrointestinal decompression and anticholinergic treatment were adopted. Instead of positive pressure ventilation treatment, preoxygenation treatment and cricoid pressure were adopted during fast induction phase to prevent the gastric contents aspiration and break into the abdominal cavity. Tracheal intubation was performed by maintaining 100% oxygen saturation. Secondly, the internal jugular vein puncture was performed guided by ultrasound at a half-sitting position under local anaesthesia. The patient was kept in a suitable posture, and the drug, liquid channel and CVP monitoring were ensured. Thirdly, the patient's special position provides the following information: in this case, half-sitting position could help to drain the blood in the pericardium to the abdominal cavity and relieve the symptom of pericardial tamponade. The most important was the treatment of hemorrhagic shock. The measures included acidosis correction, volume expansion, red blood cells and fresh frozen plasma transfusion, vital signs monitoring and effective treatment [1].
Conflicts of Interest
None.
Article Info
Article Type
Case ReportPublication history
Received: Tue 24, Nov 2020Accepted: Wed 23, Dec 2020
Published: Fri 22, Jan 2021
Copyright
© 2023 Zhongping Cao. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.DOI: 10.31487/j.IJSCR.2020.04.04
Author Info
Corresponding Author
Zhongping CaoDepartment of Anesthesia, The Special Characteristic Medicine Center of Chinese People Armed Police Force, Tianjin, China