Effective Management of a School-Acquired Cardiac Wound in a Hospital with Limited Resources: A Case Report and Review of the Literature

Blunt objects in the school environment can cause serious injuries that can be life-threatening. We report the exceptional case of a thoracic wound caused by scissors in a teenager in haemodynamic shock. The patient rapidly benefited from a multidisciplinary approach involving cardiac and thoracic surgeons and a resuscitating anesthetist, all of whom helped to preserve the adolescent's vital prognosis.

Case report: The patient was a 14 years old schoolboy who presented with a scissors thoracic wound during a game in the playground. The wound was located in the 3rd left intercostal space. The patient presented with cardiac tamponade and was rapidly taken to the surgical emergency department of the Sylvanus Olympio university hospital in Lome by non-medical transport. Rapid recognition of the severity of the lesions by the medical team in the surgical emergency department enabled rapid management in the operating theatre, where haemostasis of a cardiac wound at the left atrio-ventricular junction was successfully performed a ter emergency sternothoracotomy without the need for extracorporeal circulation, which was unavailable in our centre.

Conclusion: Blunt objects can cause serious injury in schools. Our observation highlights the need to control and monitor the use of these objects in schools, and also to raise public awareness of the seriousness of thoracic wounds. The establishment of a surgical and anaesthesia/ cardiothoracic resuscitation team with an operating theatre equipped with extracorporeal circulation is imperative in the surgical emergency department of the CHU SO for effective management of these injuries, which are not incompatible with life.

Author(s): Lamboni D*, Koulekey D, Sama H, Barnabo-Nampoukine K, Issa-Toure A and Sakiye A

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