With news yesterday that an 18 year old was stabbed in the heart yesterday on Oxford Street, I thought it would be a good time to talk about surgery that can be carried out to save someone who has been stabbed in the heart.
The process needs to be carried out extremely quickly due to the loss of blood from the heart whilst it continues to contract, which means that the victim needs to be transported to the nearest cardiothoracic theatre as soon as possible for a good chance of survival. The problem is that not all hospitals do cardiothoracic sugery (surgery on the heart), there are a number in London, as well as private hospitals all over the United Kingdom but not all cities have specialist cardiothoracic surgeons at their local hospitals.
To start the heart surgery the surgeon will open the chest cavity "through the patients breastbone" (http://tinyurl.com/czudd7b) with an incision and then pull the rib cage open using a surgical tool called a 'haight-finochietto rib retractor', which then opens up the area of the chest that the heart sits in. It should take the surgeon one minute from making the incision in the breastbone, to having has his hands on the heart.
At this point the surgeon can make a decision whether to use a "heart-lung bypass machine, which takes over the hearts pumping action and moves blood away from the heart and allows the surgeon to operate on a heart that isn't beating and has no blood in it." (http://tinyurl.com/czudd7b). Or he can do surgery on the heart while it is beating, where they will use a clamp to steady one section of the heart that needs surgery, whilst the rest of the heart beats regularly. This second process takes a lot of skill and a very steady hand.
In the case of a stabbing there will be a hole in the heart which needs to be stitched up to stop the bleeding. To get to the heart the 'pericardium' needs to be penetrated. This is a "fluid filled sack that surrounds the heart; and works to keep the heart contained in the chest cavity, limit heart motion and prevent the overexpansion of the heart" (http://tinyurl.com/dxe7deb). Once the pericardium is penetrated, the surgeon is free to stitch up the stab wound and stop the bleeding.
After the surgeon has stitched up the wound and taken off the clamp/released the heart-lung bypass machine, he can either stitch up the pericardium or leave it unstitched. If he were to stitch it up this could "increase the risk of a cardiac tamponade, a compression of the heart that can occur when blood/fluid builds up between the myocardium (heart muscle) and the pericardium" (http://tinyurl.com/crysoby).
This shows that not only does a surgeon have to be very quick in his decision making, he also has to be very calm, as he only has one chance to get it right. To see this process in action click on the link (http://www.youtube.com/watch?v=hM4u2PXyBpg), but please note that it contains images of open chest cavities and live surgery.
Unfortunatly the 18 year old who was stabbed died on scene with a single stab wound and was unable to receive any medical attention.
The process needs to be carried out extremely quickly due to the loss of blood from the heart whilst it continues to contract, which means that the victim needs to be transported to the nearest cardiothoracic theatre as soon as possible for a good chance of survival. The problem is that not all hospitals do cardiothoracic sugery (surgery on the heart), there are a number in London, as well as private hospitals all over the United Kingdom but not all cities have specialist cardiothoracic surgeons at their local hospitals.
To start the heart surgery the surgeon will open the chest cavity "through the patients breastbone" (http://tinyurl.com/czudd7b) with an incision and then pull the rib cage open using a surgical tool called a 'haight-finochietto rib retractor', which then opens up the area of the chest that the heart sits in. It should take the surgeon one minute from making the incision in the breastbone, to having has his hands on the heart.
At this point the surgeon can make a decision whether to use a "heart-lung bypass machine, which takes over the hearts pumping action and moves blood away from the heart and allows the surgeon to operate on a heart that isn't beating and has no blood in it." (http://tinyurl.com/czudd7b). Or he can do surgery on the heart while it is beating, where they will use a clamp to steady one section of the heart that needs surgery, whilst the rest of the heart beats regularly. This second process takes a lot of skill and a very steady hand.
In the case of a stabbing there will be a hole in the heart which needs to be stitched up to stop the bleeding. To get to the heart the 'pericardium' needs to be penetrated. This is a "fluid filled sack that surrounds the heart; and works to keep the heart contained in the chest cavity, limit heart motion and prevent the overexpansion of the heart" (http://tinyurl.com/dxe7deb). Once the pericardium is penetrated, the surgeon is free to stitch up the stab wound and stop the bleeding.
After the surgeon has stitched up the wound and taken off the clamp/released the heart-lung bypass machine, he can either stitch up the pericardium or leave it unstitched. If he were to stitch it up this could "increase the risk of a cardiac tamponade, a compression of the heart that can occur when blood/fluid builds up between the myocardium (heart muscle) and the pericardium" (http://tinyurl.com/crysoby).
This shows that not only does a surgeon have to be very quick in his decision making, he also has to be very calm, as he only has one chance to get it right. To see this process in action click on the link (http://www.youtube.com/watch?v=hM4u2PXyBpg), but please note that it contains images of open chest cavities and live surgery.
Unfortunatly the 18 year old who was stabbed died on scene with a single stab wound and was unable to receive any medical attention.
Really like how you're relating your blog to current events. Keep it up Ben!
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