allows exposure of the injured lung and hemostasis can be achieved with
selective suture ligation of bleeding vessels or tissues. The lung parenchyma is
then reapproximated with a running interlocking suture. The entry and exit
wounds should be left open to allow drainage and the suture line should be
tested for leak at the end of procedure.
Penetrating Injuries to the heart
Penetrating injuries to the heart in children are rare. In a recent
retrospective review of 4569 pediatric trauma patients, only 0.7% sustained a
cardiac injury. The most common mechanisms of injury are stab wounds and
gunshots. The right ventricle is the most often injured cardiac chamber,
followed by the left ventricle, because of their anterior location in the chest.
Penetrating cardiac injuries are fatal in 70% to 80% of cases.
Patients with penetrating cardiac injury may develop pericardial
tamponade. Clinical manifestations of tamponade physiology include
tachycardia, hypotension, distended neck veins, muffled heart sounds, and
pulsus paradoxus. Penetrating thoracic trauma concerning for heart injury
should quickly undergo FAST evaluation to look for pericardial fluid. In
unstable patients with hemodynamic compromise, bedside pericardiocentesis
or subxiphoid pericardial window can be life-saving, temporizing maneuvers.
Regardless of hemodynamic stability, definitive surgical repair for
penetrating cardiac injury is necessary. The chest is entered through a left