(BMJ) - A 46-yo woman arrived w/ a knife in her chest near the midclavicular line at the 5th intercostal space w/ additional wounds 3 cm above the knife and in the L hypochondrium. She had stable vital signs. What was the next step in management?
Diagnostic peritoneal lavage
Remove knife and pack wound
Left tube thoracostomy
Transfer to OR for knife removal
ED thoracotomy
You are correct. The knife was extracted under direct vision in the OR. Miraculously, it penetrated between the pericardium and the left lung, w/o any cardiac injury and just a small pulmonary laceration. Subsequent laparotomy revealed a through-and-through splenic flexure laceration and injury of the hilum of the left kidney w/ retroperitoneal hematoma.