Transmediastinal Stab & Gun Shot Wound


Background

  1. Penetrating injury that violates the mediastinum
  2. Uncommon injuries, but usually life-threatening
  3. Evaluation is challenging
  4. Incidence, prevalence:
  5. Risk factors:
  6. Morbidity, mortality

Pathophysiology

  1. Injury may involve
  2. Injury mechanisms:

Diagnostics

  1. Assume cardiac or vascular injury for all patients in shock with penetrating injury
  2. History
  3. Physical exam
  4. General trauma labs
  5. Imaging studies

Differential Diagnosis

  1. Hemo/ pneumothorax
  2. Cardiac tamponade
  3. Thoracic wall lacerations
  4. Diaphragmatic rupture
  5. Tracheobronchial injuries
  6. Esophageal injuries
  7. Spinal cord injury

Treatment
Note: ALL decisions should be made in close consultation with trauma surgery to determine best course and sequence of action

  1. ATLS ABCs
  2. 2 large bore IVs, O2, cardiac monitor
  3. Patients divided into 3 groups
  4. Definitive therapy
  5. Tetanus prophylaxis

Disposition

  1. Admit to OR or trauma