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Penetrating cardiac injury — DIPIMC MCQ

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HardPre-Hospital TraumaPenetrating cardiac injuryDIPIMCDipIMC

A 19-year-old has a single stab wound to the left chest just medial to the nipple. He loses output and arrests in front of your enhanced-care team within a minute of your arrival, having had a brief period of muffled heart sounds and distended neck veins beforehand. Tension pneumothorax has been excluded by bilateral thoracostomies. What is the most appropriate intervention?

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Correct answer: E — Perform a resuscitative (clamshell) thoracotomy to relieve cardiac tamponade

A penetrating wound in the cardiac box with witnessed arrest and signs of tamponade is the classic indication for pre-hospital resuscitative thoracotomy by a trained team, which relieves tamponade and allows control of cardiac wounds. Compressions and adrenaline are ineffective against a compressed heart, and needle pericardiocentesis is unreliable for clotted blood. Defibrillation does not treat the mechanical cause. Pearl: the intervention is time-critical, with meaningful survival seen mainly when it is performed within minutes of arrest.

Reference: Faculty of Pre-Hospital Care (RCSEd); Resuscitation Council UK Guidelines 2025 (Special Circumstances)