Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXVIII: Wounds and Injuries of the Chest

Pericardial Tamponade

United States Department of Defense

The great majority of missile wounds of the heart create a pericardial defect which allows blood from the lacerated myocardium to freely escape. Tamponade cannot occur and death results from exsanguination. Small fragment wounds are compatible with tamponade. As blood collects in the pericardial space, the transmural pressure gradient progressively falls, resulting in collapse of the great veins and displacement of the intraventricular septum to the left. As blood continues to collect, venous pressure rises and cardiac output and blood pressure fall. Because of the nonlinear pressure-volume characteristics of the pericardium, a point is ultimately reached at which a small additional increment of blood will result in sudden cardiovascular collapse and death.

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Operational Medicine 2001

Health Care in Military Settings

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