This is a case report of a patient with a stab injury into the heart. It highlights the successful management in view of the limited facilities and personnel in a district hospital. This may probably be the first operation of its kind in the country.
Cardiac concussion is a sudden, direct blunt trauma cause to the chest which led to death. However, there are patients who did not completely fulfil this definition. We report two cases which did not fit into the definition domain. Two male patients presented to Emergency Department with moderate anterior chest pain after motor vehicle crash showed transient anterior ST segment elevation at chest lead V2 and V3 with raised creatine kinase and normal troponin T. The electrocardiogram changes fully resolved after 24 hours. Both patients were discharged uneventfully after 24 hours monitoring in Emergency Department short-stay ward. Conventional definition of cardiac concussion (commotion cordis) and cardiac contusion may be unsuitable to describe these cases. Therefore, we propose the diagnosis of focal
cardiac concussion. We also highlighted the ability of Emergency Department to manage these patients in short-stay ward.
Keywords: commotio cordis, chest pain, nonpenetrating, electrocardiography
An 18-year-old construction worker suddenly collapsed while handling a power-actuated nail gun and died shortly after. A neat, almost circular puncture wound was found on the front of his left chest. No fire-arm residues were detected on the surrounding skin. The police stated that it was an accidental injury, at a construction site, where a nail fired from a nail gun by the deceased had deflected off the wall and struck him on the front of the chest. Since the entry wound appeared to be a neat hole, and that too on the front of the left chest overlying the heart area, there was reluctance on the part of the pathologist to accept it as an accidental injury due to a ricochet. A visit to the scene, interrogation of witnesses, examination of the alleged tool and post-mortem X-ray of the deceased were undertaken prior to autopsy. A bent nail was found in the heart. The scene visit and the subsequent autopsy revealed that the nail took a roughly circular flightpath after it had struck the wall, all the while travelling with its pointed end directed forward. Within the body too, the nail maintained the same path. Various medicolegal issues are discussed pertaining to nail-gun injuries. The importance of a visit to the scene, examination of the alleged tool, interrogation of witnesses and the X-ray of the body, all prior to autopsy, are emphasized. The conclusion was: accidental death due to the unusual ricochet of a nail.
A case of unsuspected penetrating cardiac injury is presented. It was recognised by the presence of bleeding into peritoneal cavity even after the source of bleeding from intra-abdominal organs had been stopped. It highlights the importance of high index of suspicion of associated cardiac injury in high epigastric penetrating injury.
An injury to the left ventricle after a chest tube insertion is a rare but lethal phenomenon that is likely to occur if precautions are not seriously addressed. We present a 15-year-old girl who was diagnosed a left empyema thoracis. An attempt to place a chest drain in this young girl was almost fatal. A left ventricular repair together with thoracotomy and decortication were successful. This case emphasizes the rarity of this lethal complication and the importance of the correct technique for chest tube insertion.
Flying feather is a traditional street weapon, which is believed to be originated from Philippine. It is a famous weapon in Tawau, Sabah, shot within short distance and being used with the aim to debilitate the victims. Some may even apply poison at the tip of the weapon. We report two cases of severe chest injuries in resulting from flying feathers. Case 1, a 25-year old man sustained left sided hemothorax with anterior right ventricle injury. He underwent thoracotomy and was discharged well. Case 2, a 40-year old man, presented to emergency department with no signs of life, sustained penetrating injury to the left second intercostal muscle, the pericardium and the anterior wall of the right ventricle adjacent to the interventricular septum. These cases highlight the severity spectrum of cardiac injury resulting from flying feathers.