Hemopericardium from penetrating injuries

Tamponade from hemopericardium after penetrating cardiac injury occurs when fluid accumulating in the pericardial sac is not decompressed into the pleural cavity via the pericardial rent. The incidence of tamponade is 2 per cent of stab or gunshot wounds to the chest, back, and upper abdomen; fatal tamponade has been reported after a one-inch stab wound in the right mid-axilla. After penetrating injury, the full clinical picture of tamponade may develop within minutes, or slowly over periods of days. This is because the knife or gunshot also tears the pericardial sac which allows the pericardial blood to decompress into the pleural cavity or mediastinum. Tamponade occurs when the egress of pericardial blood is obstructed by clots that form in the pericardial space shortly after laceration of a cardiac chamber; large clots were found in 60 per cent of patients operated on for tamponade. Although tamponade from penetrating cardiac wounds has a low incidence, disastrous consequences occur when the diagnosis is delayed or missed. The lack of specificity of routine monitoring means that a high degree of suspicion should be exercised in trauma patients.

Iatrogenic tamponade occurs with manipulation of instruments and catheters that inadvertently perforate the wall or the right atrium or ventricle during cardiac catheterization or biopsy, or during placement of pacemakers or central venous catheters. This occurs most commonly in patients with ischemic or severely diseased ventricles. In contrast with penetrating cardiac wounds, tamponade accidentally occurring after catheter manipulation may be fatal unless rapidly corrected by pericardiotomy and drainage because there is no route for spontaneous decompression of the pericardial fluid.

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