TY - JOUR T1 - Damage control open mediastinum in the management of penetrating cardiac injury JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000812 VL - 6 IS - 1 SP - e000812 AU - Peng Yu AU - Ashley Levine AU - Weidun Guo Y1 - 2021/11/01 UR - http://tsaco.bmj.com/content/6/1/e000812.abstract N2 - A woman in her early 30s presented to a level 1 trauma center with a single through-and-through gunshot wound to the lower sternum and left posterior chest. She was hypotensive and tachycardic on arrival. Physical examination and chest X-ray suggested left hemothorax. An emergent left tube thoracostomy drained 200 mL of fresh blood. A focused assessment with sonography for trauma was equivocal for hemopericardium, while demonstrating a trace amount of fluid in the left upper abdomen. A massive transfusion protocol was initiated and she was taken to the operating room for an emergent median sternotomy due to a high suspicion for cardiac injury and an intra-abdominal involvement. Intraoperatively, a 3 cm right ventricle laceration was identified and a cardiorrhaphy was performed. Intrathoracic cardiac massages were necessitated due to asystole. The patient’s abdomen was noted more distended and firmer, and the bullet trajectory was identified coursing into the abdomen. A subsequent exploratory laparotomy revealed hemoperitoneum, liver laceration, and spleen laceration. These injuries required a splenectomy, liver packing, and negative-pressure abdominal packing. The patient received 47 units of packed red blood cells, rationed with fresh frozen plasma and platelets. She became coagulopathic, … ER -