Cardiac stab injury

A 51-year-old man with previous psychiatric history and suicidal attempts stabbed himself in the left lower chest with a long steak knife. He was brought by paramedics into the resuscitation room at Auckland City Hospital alive and with the knife in situ. In the emergency department, he was alert and surprisingly cooperative (with a Glasgow Coma Scale 15); his vital signs revealed heart rate 56 beats per minute, systolic blood pressure 140 mmHg, and respiratory rate 10 breaths per minute. Initial chest auscultation demonstrated good air entry to the lung fields bilaterally. His heart sounds were clear and jugular venous pressure was not elevated. Chest X-ray did not show any evidence of haemothorax or pneumothorax. Focussed assessment by sonography for trauma (FAST) scan was not available at the time. He was taken urgently to the operating theatre where the knife was removed and the laceration of the right ventricle sutured. Figure 1: Knife in situ of chest cavit