TY - JOUR T1 - Tricuspid bullet embolism: lessons learnt from a rare firearm sequelae JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2020-000657 VL - 6 IS - 1 SP - e000657 AU - Yuqi Zhang AU - Marianna Papageorge AU - Whitney Brandt AU - Arnar Geirsson AU - Syed A Jamal Bokhari AU - Robert D Becher AU - Kimberly A Davis AU - Felix Lui Y1 - 2021/02/01 UR - http://tsaco.bmj.com/content/6/1/e000657.abstract N2 - This is a case of a patient in his 20s who presented with seven gunshot wounds to his extremities and abdomen. On arrival, the patient was intubated, and the massive transfusion protocol was initiated. Focused abdominal sonogram for trauma (FAST) demonstrated questionable pericardial fluid and positive intraperitoneal fluid. Chest radiography (chest X-ray; CXR) demonstrated a right hemopneumothorax, right lateral fifth rib fracture, right anterior fifth costal cartilage fracture and bullet shrapnel overlying right hemithorax (figure 1).Figure 1 Chest X-ray taken in the trauma bay showing bullet shrapnel overlying right hemithorax and mid-chest with large right-sided hydropneumothorax and opacification of right lung. Cardiomediastinal silhouette is partially obscured by the right lung. Right-sided rib fracture is also noted.The patient was taken emergently for an exploratory laparotomy. He was found to have ballistic injuries to his liver (caudate and dome), diaphragm, stomach and colon. He underwent posterior stomach wedge resection, resection of distal colon and was left in discontinuity. Due to the possible pericardial effusion seen on FAST, an intraoperative transesophageal echocardiography (TEE) was performed by the cardiac anesthesiology team, which was determined to be normal. At the end of the case, a temporary abdominal closure was placed, and he was transferred to the surgical intensive care unit.Postoperatively, completion CT … ER -