J Cardiovasc Surg
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Case Reports
Bullet embolism following gunshot wound of the chest. Case report and review of the literature.
A 24 year old male was shot in the low left posterior chest. Initial x-rays localized the bullet in the region of the left atrium or pulmonary veins. ⋯ Sixty-one cases with gunshot wound to the chest and 63 arterial emboli were reviewed. There was a mortality rate of 38%.
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A precipitate observed in Hartman's solution used to prime a cardiopulmonary bypass circuit was identified as calcium carbonate. Analysis of the chemical equilibrium showed that the precipitation was caused by sodium bicarbonate added to prevent acidosis. Although this practice is acceptable for haemic primes, in which buffers and albumins will prevent precipitation, it should not be done with non-haemic primes prior to bypass.