TY - JOUR T1 - Delayed cardiac herniation after a traumatic pericardial rupture in a polytrauma patient JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000874 VL - 7 IS - 1 SP - e000874 AU - Samia Berrichi AU - Mohamed Zakaria Bouayed AU - Saïda Amaqdouf AU - Ayoub Abetti AU - Sara Berrajaa AU - Ilias Benaini AU - Houssam Bkiyar AU - Nabila Ismaili AU - Noha El Ouafi AU - Brahim Housni Y1 - 2022/03/01 UR - http://tsaco.bmj.com/content/7/1/e000874.abstract N2 - An adult male patient in his 30s, with no medical history was admitted to a local hospital after sustaining a fall off an 8 m high scaffold. Initial clinical assessment revealed an unconscious patient with a GCS of 8/15 (eye opening: 1; verbal response: 2; motor response: 5), pupils equal and reactive to light, a pulse of 107 bpm, a blood pressure of 100/60 mm Hg, a respiration rate of 24cpm, with an O2 saturation of 87% on ambient air. The patient was intubated and a full-body CT scan was performed revealing a 4 mm frontoparietal subdural hematoma, an undisplaced fracture of the right frontal bone with a subgaleal hematoma and an ipsilateral eyelid edema, a right hemopneumothorax along with pulmonary contusion and ipsilateral flail chest as well as a subcutaneous emphysema spreading to the neck. No injuries were found in the abdomen. An X-ray of the upper right limb revealed a fractured humerus stabilized using a brace.The hemopneumothorax was drained but the patient developed shortly afterwards a hypotension of 80/50 mm Hg refractory to volume expansion using isotonic saline. A femoral central venous line was taken and norepinephrine was initiated. A FAST (Focused Assessment with Sonography for Trauma) examination was performed and came back normal. The patient was referred to Mohammed VI University hospital for specialized management.The patient was admitted within an hour and a half from the causing accident. At admission, our assessment found an unconscious patient, intubated and ventilated, anisocoric, with a blood pressure of 95/50 mm Hg under norepinephrine, a heartbeat of 120 bpm, a respiration rate of 26 cpm and a O2 saturation of 95% under mechanical ventilation. A continuous infusion of norepinephrine … ER -