Unsuspected mediastinal traverse

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Dear sal

Thank you for your clear comments.

I ask you one more question.
Can't bullet who shot in the heart induce cardiac tamponade?

Sorry, if this question was too elementary.
 
----- Original Message ----- 
送信者: sjasmd at aol.com<sjasmd at aol.com>
宛先: trauma-list at trauma.org
日付:Wednesday, September, 16, 2009, 01:52 PM
件名: Re: Unsuspected mediastinal traverse

>  Dear Kobe
> The greatest concern is embolism and obstruction of vasculature. Bullets are g
enerally inert in plasma environment and do not cause lead toxicity. Lead toxici
ty is more likely when bullets are left within joints. 
> Bullets in the heart can cause psychological trauma? in the patient . However 
the risks of attempting cardiac extraction are likely higher than the benefits o
f removing them.? Generally surgical extraction can be very difficult because th
e bullet may migrate out of the surgical field. 
> 
> >From time to time one does see a report of extraction of bullets from the hea
rt by interventional radiology. It is probably easier than surgical extraction b
ecause of the real-time visualization of the bullet. However it is not an easy p
rocedure. A variety of endovascular tools are used includling snares and baskets
.? Because I did not want to traumatize the endocardium by opening up a basket i
n the heart, I elected to use a balloon to perform embolectomy.
> 
> sal


KOBE Yoshiro M.D.

Department of Emergency and Critical Care Medecine
Kimitsu Chuo Hospital
Chiba, Japan

y-kobe at umin.ac.jp

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