J Korean Soc Traumatol.  2015 Sep;28(3):211-214. 10.0000/jti.2015.28.3.211.

Pericardial Tamponade following Perihepatic Gauze Packing for Blunt Hepatic Injury

• Ye JB
• Sul YH
• Go SJ
• Kwon OS
• Kim JS
• Park SS
• Ku GW
• Lee MK
• Kim YC

• KMID: 2224064
• DOI: http://doi.org/10.0000/jti.2015.28.3.211

Abstract

The primary and secondary survey was designed to identify all of a patient's injuries and prioritize their management. However 15 to 22.3% of patient with missed injuries had clinically significant missed injuries. To reduce missed injury, special attention should be focused on patients with severe anatomical injury or obtunded. Victims of blunt trauma commonly had multiple system involvement. Some reports indicate that inexperience, breakdown of estalished protocol, clinical error, and restriction of imaging studies may be responsible for presence of missed injury. The best way of reducing clinical significant of missed injuries was repeated clinical assessment. Here we report a case of severe blunt hepatic injury patient and pericardial injury that was missed in primary and secondary survey. After damage control surgery of hepatic injury, she remained hemodynamically unstable. Further investigation found cardiac tamponade during intensive care. This was managed by pericardial window operation through previous abdominal incision and abdominal wound closure was performed.

Keyword

Primary survey; Secondary survey; Missed injury; Blunt hepatic injury; Pericardial tamponade

MeSH Terms

Abdominal Wound Closure Techniques
Cardiac Tamponade*
Clinical Protocols
Humans
Critical Care