PENETRATING TRAUMA



Penetrating cardiac injuries may be due to ex­ternal objects such as bullets or knives and also bony fragments occurring from chest injury. Be­cause of its anterior location, the right ventricle is most commonly involved. Iatrogenic causes of cardiac penetrating injury include perforation of the heart during catheterization or cardiac trauma from cardiopulmonary resuscitation.
Penetrating injury to the heart may present as exsanguinating hemorrhage with hemothorax or cardiac tamponade if hemorrhage has been lim­ited to within the pericardial sac. Immediate per­icardiocentesis and administration of large vol­umes of fluids may be performed as preparations are being made for emergency surgery. A “post-pericardiotomy” type of pericarditis, infection, arrhythmias, aneurysm formation, and ventricu­lar septal defects are late complications of pene­trating cardiac injury. The risk of bacterial en­docarditis, infection from a retained foreign body, and foreign body embolus are complications pe­culiar to penetrating as opposed to nonpenetrat­ing injuries.