Penetrating cardiac injury is associated with high mortality rates. Profuse bleeding from the cardiac wound and cardiac tamponade are the usual cause of death. We report a 29 -year-old man who attempted suicide by self -inflicting stab wound to the left chest with a knife, causing cardiac tamponade and left ventricular injury. The patient was diagnosed by chest point -of-care ultrasonography in the emergency department and operated successfully in a district hospital without cardiac surgery service.

TRACHEA INJURY IN A POLYTRAUMA PATIENT WITH AN INTRATHORACIC MIGRATION OF FOREIGN BODIES Traumatic airway injuries with intrathoracic foreign body migration are rare but can be severe and life-threatening. Prompt clinical suspicion is crucial to secure the airway and prevent further respiratory distress. Imaging is important in depicting the nature of the injury and its possible complications. We are reporting the case of a 26-year-old motorcyclist who was involved in a high-velocity road traffic accident and had extensive polytrauma with an airway injury. He was intubated and required an urgent thoracostomy for the pneumothorax. Computed tomography revealed trachea injury with intrathoracic and mediastinal foreign body migration. The patient was planned for a thoracotomy or video-assisted thoracoscopic surgery (VATS) approach for the removal of the foreign bodies. However, his condition gradually deteriorated, and he passed away due to a severe head injury.

Background: Perioperative red blood cell (RBC) transfusion in coronary artery bypass grafting (CABG) has both benefits and harms. Our aim was to study the association between perioperative RBC transfusion and its adverse outcomes. Methods: This was a retrospective study of patients who underwent isolated CABG in Hospital Universiti Sains Malaysia, Kelantan, Malaysia, from 1 January 2013 until 31 December 2017. Data were collected from medical records, and comparisons were made between patients who received perioperative RBC transfusions and those who did not have adverse outcomes after CABG. Results: A total of 108 patients who underwent isolated CABG were included in our study, and 78 patients received perioperative RBC transfusions. Patients who received perioperative RBC transfusions compared to those who did not were significantly more likely to develop prolonged ventilatory support (21.8% versus 0%, P = 0.003), cardiac morbidity (14.1% versus 0%, P = 0.032), renal morbidity (28.2% versus 3.3%, P = 0.005) and serious infection (20.5% versus 3.3%, P = 0.037). With each unit of packed RBC transfusions, there was a significantly increased risk of prolonged ventilatory support (adjusted odds ratio [AOR] = 1.45; 95% confidence interval [CI] = 1.20–1.77; P < 0.001), cardiac morbidity (AOR =1.40; 95%CI = 1.01–1.79; P = 0.007), renal morbidity (AOR = 1.23; 95%CI = 1.03–1.45; P = 0.019) and serious infection (AOR = 1.31; 95%CI = 1.07–1.60; P = 0.009). Conclusion: Perioperative RBC transfusion in isolated CABG patients is associated with increased risks of developing adverse events such as prolonged ventilatory support, cardiac morbidity, renal morbidity and serious infection.