title: Penetrating nail-gun injury of the heart managed by adenosine-induced asystole in the absence of a heart-lung machine.
abstract: During his work, an 18-year-old carpenter-in-training overbalanced and shot himself in the left median thorax with a nail gun. The patient was delivered to our thoracic surgery unit with a tentative diagnosis of penetrating lung trauma. An emergent computed tomogram showed a heart-penetrating nail injury. The patient was taken to the operating room, where he underwent emergency surgery that included sternotomy, pericardiotomy, extraction of the nail, and trauma treatment of the heart injury. The surgery was performed in a unit without a heart-lung machine. For that reason, asystole was chemically induced by the intravenous administration of adenosine. The surgery was successful, and the patient was discharged from the hospital on the 10th postoperative day. In cases of penetrating injuries of the heart, especially those with a foreign body retained in situ, we believe that the intravenous administration of adenosine is an elegant solution for the rapid provocation of asystole. In contrast to other methods, adenosine-induced asystole enables relatively safe myocardial manipulation in the absence of a cardiac surgical unit and a heart-lung machine.
authors.affiliation: Surgical Department 1, Clinical Center Fuerth, Fuerth 90766, Bavaria, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Rupprecht
authors.affiliation: Surgical Department 1, Clinical Center Fuerth, Fuerth 90766, Bavaria, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Ghidau
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000627:therapeutic use*; D061605:Administration, Intravenous; D000293:Adolescent; D006348:Cardiac Surgical Procedures; D004630:Emergencies; D005547:Foreign Bodies; D006297:Health Services Accessibility; D006323:Heart Arrest / Q000503:physiopathology*; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006355:Heart-Lung Machine; D006801:Humans; D008297:Male; D060051:Occupational Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*
chemical_list: D000241:Adenosine
keywords: Accidents, occupational; adenosine/administration & dosage; asystole, induced; cardiac tamponade/therapy; emergency medical services/standards; foreign bodies; heart arrest, induced; heart injuries/surgery; heart ventricles/injuries; heart-lung machine; wounds, penetrating/surgery