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Thu Oct 19 16:51:44 BST 2006

This is a rather intimate level of detail.  Did the patient give consent for it to be broadcast over the internet?
  ----- Original Message ----- 
  From: M2darwin at aol.com 
  To: crippen+ at pitt.edu ; ccm-l at ccm-l.org 
  Sent: Thursday, October 19, 2006 3:42 PM
  Subject: ccml Stingray again!

  An 82 year old Florida man was impaled by a stingray barb from a stingray that jumped into the boat he was in and stung him. The barb entered the inferior wall of the LV just below the tricuspid valve and was then drawn through the heart and through the wall of the RV. The ratchet nature of the barbs reportedly moved the barb through the heart due to ventricular contractions and chest wall motion from breathing. The barb was not acutely removed, and the patient was transferred to a Level One trauma center in Broward county, FL. He was taken to theater, put on CPB, and the barb was removed by pulling it through the heart after decompressing the pericardial tamponade which had developed. The ventricular and septal perforations were repaired with purse string sutures. The echo is truly amazing!

  The patient is stable and doing well following surgery. Of course, he faces the usual post-op risks of DVTs, sepsis, and the like. As the surgeon emphasized, a big difference between this gentleman and Steve Irwin was that first responders did not remove the barb. Luckily, it had broken off inside the chest and the piece that worked its way through both ventricles was 6 cm long.

  Aside from intense chest pain, the patient did not seem to suffer any cardiac effects from envenomation.

  Mike Darwin

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ccml Stingray again!