The American surgeon
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The American surgeon · Dec 1994
Case ReportsMissile embolization revisited: a rationale for selective management.
Embolization of missiles is an unusual presentation of penetrating trauma. Often the management of these injuries may be quite challenging, and selective management continues to be subject to controversy. ⋯ It also recommends operative intervention for symptomatic venous emboli to the heart and pulmonary circulation. Nonoperative management may be considered in patients with asymptomatic emboli to the right heart or the cerebral and pulmonary circulation.
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The American surgeon · Dec 1994
Case ReportsRapid right atrial cannulation for fluid infusion during resuscitative emergency department thoracotomy.
A simple rapid technique for cannulating the right atrium during a resuscitative Emergency Department thoracotomy (EDT) for exsanguinating trauma is described. Following the thoracotomy and pericardiotomy, an ordinary Foley urinary bladder balloon catheter is inserted into the right atrial appendage for rapid, large volume normothermic blood and fluid infusion. A method for simplifying this maneuver, as well as the potential complications of over-resuscitation with myocardial distention and fluid overload, myocardial cooling, air embolism, and tricuspid valve occlusion are discussed. We recognize that this technique is radical and applicable to only a limited subset of severely injured patients, for example, victims of non-cardiac penetrating trauma who arrive at the hospital moribund or who arrest in the emergency center.