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- W1973021372 abstract "A 32 year old man was brought by emergency ambulance to the Accident and Emergency (A & E) Department at Glasgow Royal Infirmary, arriving at 0349 hrs. He had been stabbed once in the chest with an unknown weapon. On examination there was a wound 2 cm to the left of the sternum in the 6th intercostal space. There were no other external injuries. Initial assessment revealed a clear airway, respirations of 4O/min, pulse rate of 125/min, and blood pressure (BP) of 140/120 mmHg. The trachea was central with normal bilateral air entry. He was drowsy (Glasgow Coma Scale E3 M6 V4) and smelled of alcohol, but was orientated and obeying commands. He was cold, clammy and sweaty and had distended neck veins. Treatment was started with high flow oxygen, two wide bore peripheral intravenous cannulae and a rapid infusion of two litres of crystalloid. Eight units of group specific blood were requested. A cardiothoracic opinion was sought urgently as the likely diagnosis was cardiac tamponade and equipment was prepared for an emergency room thoracotomy. A chest radiograph was normal. A right internal jugular cannula was inserted and a central venous pressure (CVP) of 20 cm H,O was measured as his BP dropped to 85/50 mmHg. An emergency echocardiogram was performed in the resuscitation room, which confirmed cardiac tamponade. A 4 cm effusion was demonstrated anteriorly with right sided chamber collapse. Pericardiocentesis was carried out under echocardiographic guidance using a 14 gauge needle and a single lumen central venous catheter (Leader Cath, Vygon UK Ltd, Gloucestershire, England) was inserted into the pericardium over a guidewire (F@w 2); 150 ml of blood drained in 5 min with an immediate improvement in his haemodynamic status (pulse 98 bpm, BP 98/59 mmHg, GCS E4 M6 V4). He was then transferred to the Cardiothoracic Surgical Intensive Care Unit for observation. He remained haemodynamically stable over the next few hours. The CVP remained normal and there was no evidence of pulsus paradoxus. He was given intravenous antibiotics and during the first 72 h he drained a further 350 ml of blood (via the catheter) but remained haemodynamically stable. He was transferred to the main cardiothoracic ward 28 h after admission and the catheter was removed on the third day after a repeat echocardiogram confirmed the absence of pericardial fluid. He was discharged the following day without complication. At outpatient review the heart size was normal and no other abnormality was seen on electrocardiography or the chest radiograph." @default.
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- W1973021372 date "1998-07-01" @default.
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- W1973021372 title "Acute traumatic cardiac tamponade treated solely by percutaneous pericardial drainage" @default.
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- W1973021372 doi "https://doi.org/10.1016/s0020-1383(98)00053-9" @default.
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