Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2019  |  Volume : 12  |  Issue : 1  |  Page : 72-73
A lethal cardiac injury inflicted by a nonlethal weapon


1 Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia; Department of Surgery, Westchester Medical Center, New York Medical College, New York, USA
2 Department of Surgery, Westchester Medical Center, New York Medical College, New York, USA

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Date of Submission11-Oct-2018
Date of Acceptance16-Oct-2019
Date of Web Publication22-Apr-2019
 

How to cite this article:
Gachabayov M, Latifi R. A lethal cardiac injury inflicted by a nonlethal weapon. J Emerg Trauma Shock 2019;12:72-3

How to cite this URL:
Gachabayov M, Latifi R. A lethal cardiac injury inflicted by a nonlethal weapon. J Emerg Trauma Shock [serial online] 2019 [cited 2019 May 24];12:72-3. Available from: http://www.onlinejets.org/text.asp?2019/12/1/72/256620




Dear Editor,

A 15-year-old male patient was admitted 26-min after having been inadvertently shot by his brother. He was shot at a close range while playing with an air rifle. On admission: The patient was unconscious and cyanotic. Physical examination revealed Beck's triad [Figure 1]. Radial pulse and BP were not palpable. The entry wound was 0.4 cm in diameter located over the sternum at the level of 5th costal cartilage. Emergency department thoracotomy with pericardiotomy was performed. Cardiac tamponade was resolved. A 0.4 mm defect was found in the right atrial wall which was repaired with nonabsorbable suture. The patient developed acute kidney injury, and subsequently multiorgan dysfunction. On the second postoperative day, the patient died.
Figure 1: Patient with 0.4 cm pellet gun wound over the sternum, cyanosis, and jugular vein distention

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Even though air guns and rifles are considered nonlethal or less-lethal weapons, they can inflict life-threatening injuries, especially when used at a close range. The mechanism of propulsive power in air weapons is sudden decompression of a compressed gas.[1] Muzzle velocity of air weapons may vary from 60 to 380 mm/s depending on the power source and mechanism.[2] However, despite air weapons are nonlethal, their muzzle velocity often exceeds the velocity required to penetrate eye (39 m/s),[3] skin (38–70 m/s),[4] and bone (106 m/s).[5] Moreover, given lower temperatures produced by pellets as compared to powdered weapon projectiles, injuries caused by them have a higher preponderance for bacterial contamination. Several cardiac injuries inflicted by air weapons have been reported so far. The tragedy with air guns, in particular, is that the highest rate is observed in the age range of 10–14 years (48.4 in 100,000) and 66% of those injuries are unintentional.[6] McNeill and Annest reported the composite rate of air weapon injury in boys aged 1–14 to be 121.1/100,000 population a year.[7]

Clinical presentation, complications, and outcomes of cardiac injuries caused by air weapons vary from a stable patient with dysrhythmia from an intrapericardial pellet [8] to cardiac tamponade causing death shortly.[9] Emergency thoracic exploration is warranted when the patient presents with Beck's triad or massive bleeding with the rate >200 ml/h. Cardiac tamponade even requires emergency department thoracotomy as even a minute delay may be fatal.

To conclude, surgeons, emergency room physicians, and other specialists should be aware that injuries inflicted by nonlethal weapons, namely air weapons may be serious, even lethal.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Di Maio VJ. Gun Shot Wound. 2nd ed. New York: Elsevier; 1985. p. 227-30.  Back to cited text no. 1
    
2.
Harris W, Luterman A, Curreri PW. BB and pellet guns – Toys or deadly weapons? J Trauma 1983;23:566-9.  Back to cited text no. 2
    
3.
Bowen DI, Magauran DM. Ocular injuries caused by airgun pellets: An analysis of 105 cases. Br Med J 1973;1:333-7.  Back to cited text no. 3
    
4.
Shaw MD, Galbraith S. Penetrating airgun injuries of the head. Br J Surg 1977;64:221-4.  Back to cited text no. 4
    
5.
Di Maio VJ. Penetration of the skin by bullets and missiles. Forensic Sci Gaz 1980;11:1-2.  Back to cited text no. 5
    
6.
Nguyen MH, Annest JL, Mercy JA, Ryan GW, Fingerhut LA. Trends in BB/pellet gun injuries in children and teenagers in the United States, 1985-99. Inj Prev 2002;8:185-91.  Back to cited text no. 6
    
7.
McNeill AM, Annest JL. The ongoing hazard of BB and pellet gun-related injuries in the United States. Ann Emerg Med 1995;26:187-94.  Back to cited text no. 7
    
8.
Willemsen P, Kuo J, Azzu A. Dysrhythymia from an intrapericardial air gun pellet: A case report. Eur J Cardiothorac Surg 1996;10:461-2.  Back to cited text no. 8
    
9.
Bakovic M, Petrovecki V, Strinovic D, Mayer D. Shot through the heart-firepower and potential lethality of air weapons. J Forensic Sci 2014;59:1658-61.  Back to cited text no. 9
    

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Correspondence Address:
Dr. Mahir Gachabayov
Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia; Department of Surgery, Westchester Medical Center, New York Medical College, New York

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_111_18

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