title: Successful emergency department thoracotomy for traumatic cardiac rupture: effective utilization of a fret sternum saw.
abstract: Mortality following blunt chest injury and cardiac rupture remains high despite advances in the care of traumatic injuries. Indeed, most patients succumb to these injuries even prior to reaching a hospital. However, timely recognition and surgical intervention can save lives. We present the case of a 40-year-old woman who presented to our emergency department in cardiac arrest due to rupture of her left atrium following a major motor vehicle collision. The patient underwent emergency department thoracotomy with successful repair of the cardiac rupture. Emergency department thoracotomy, when indicated and performed by trained surgeons, can be the only life-saving procedure available. Rapid median sternotomy using a cost-effective fret sternum saw does not require significantly more time than a left lateral thoracotomy or clamshell incision in an emergency situation. It can be an effective and alternative method of thoracic entry in the emergency department. Prognosis of cardiac rupture depends largely on the mechanism of injury, location of injury, signs of life: vital signs, and availability of timely intervention. When indicated, hesitation should be avoided. Expedient cardiac exposure is essential and leads to better results with improved survival rates in patients with blunt cardiac rupture.
authors.affiliation: Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Surgery, Omihachiman Community Medical Center, Shiga, Japan. tsukasa@koto.kpu-m.ac.jp.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Surgery, Omihachiman Community Medical Center, Shiga, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Masuda
authors.affiliation: Department of Anesthesiology, Omihachiman Community Medical Center, Shiga, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Hitomi
authors.affiliation: Department of Surgery, Omihachiman Community Medical Center, Shiga, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Osaka
authors.affiliation: Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Nakao
authors.affiliation: Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Yoshimura
mesh_terms: D000328:Adult; D002305:Cardiac Tamponade; D004636:Emergency Service, Hospital; D005260:Female; D006335:Heart Injuries; D006801:Humans; D013249:Sternum / Q000601:surgery*; D013908:Thoracotomy / Q000295:instrumentation* / Q000379:methods; D013997:Time Factors; D014949:Wounds, Nonpenetrating