45 year old man fell into a well, thus sustaining multiple injuries – Fractures of the sternum and both left forearm bones, contusion of cervical spine and left knee joint injury.
Presented in shock and respiratory insufficiency. Resuscitated and quick total body scan was done which showed multiple fractures and massive haemopericardium resulting in cardiac tamponade. He required ventilation and ionotropic support along with colloid and crystalloid administration. A quick decision was taken to shift him to the Cardiac OT. Per-operatively, a tear in LA Appendage was successfully repaired without cardio-pulmonary bypass. The unexpected tear in the LA- Appendage was caught with Duval forceps and repaired successfully using two layers of 5,0 Proline Sutures. During opening of the chest, BP dropped to 50mm (S) and after I applied clamp onto the LAA, he suffered a cardiac arrest (hypovolaemic). Blood was rushed and adrenaline shot was also given to gain time. After control of the tear the patient became haemodynamically stable. He did have deranged RFTs and LFTs post-operatively, which recovered in a week’s time. He was discharged home on 12th post-op day.
- Dr.Ashwani Suri
References:
http://link.springer.com/article/10.1007%2Fs00068-002-1191-2#page-1
http://www.journalofthesaudiheart.com/article/S1016-7315(12)00358-2/fulltext
http://asianannals.ctsnetjournals.org/cgi/content/full/9/2/125
Presented in shock and respiratory insufficiency. Resuscitated and quick total body scan was done which showed multiple fractures and massive haemopericardium resulting in cardiac tamponade. He required ventilation and ionotropic support along with colloid and crystalloid administration. A quick decision was taken to shift him to the Cardiac OT. Per-operatively, a tear in LA Appendage was successfully repaired without cardio-pulmonary bypass. The unexpected tear in the LA- Appendage was caught with Duval forceps and repaired successfully using two layers of 5,0 Proline Sutures. During opening of the chest, BP dropped to 50mm (S) and after I applied clamp onto the LAA, he suffered a cardiac arrest (hypovolaemic). Blood was rushed and adrenaline shot was also given to gain time. After control of the tear the patient became haemodynamically stable. He did have deranged RFTs and LFTs post-operatively, which recovered in a week’s time. He was discharged home on 12th post-op day.
- Dr.Ashwani Suri
References:
http://link.springer.com/article/10.1007%2Fs00068-002-1191-2#page-1
http://www.journalofthesaudiheart.com/article/S1016-7315(12)00358-2/fulltext
http://asianannals.ctsnetjournals.org/cgi/content/full/9/2/125
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