Journal of Emergencies, Trauma, and Shock

LETTER TO EDITOR
Year
: 2019  |  Volume : 12  |  Issue : 1  |  Page : 72--73

A lethal cardiac injury inflicted by a nonlethal weapon


Mahir Gachabayov1, Rifat Latifi2,  
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

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




How to cite this article:
Gachabayov M, Latifi R. A lethal cardiac injury inflicted by a nonlethal weapon.J Emerg Trauma Shock 2019;12:72-73


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 2020 Nov 26 ];12:72-73
Available from: https://www.onlinejets.org/text.asp?2019/12/1/72/256620


Full Text



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}

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

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