Double Jeopardy Injuries: Improved Clinical Outcomes With FAST Imaging and Subxiphoid Pericardial Window for Combined Cardiac and Abdominal Stab Wounds.

This study examines the management of patients with combined penetrating cardiac and intra-abdominal stab wounds—referred to as "double jeopardy"—over a 12-year period at a major trauma center in South Africa. It highlights how the introduction of Focused Assessment with Sonography in Trauma (FAST) and Subxiphoid Pericardial Windows (SPWs) in 2013 improved diagnostic accuracy, reduced the need for simultaneous thoracotomy and laparotomy, and influenced operative sequencing by prioritizing cardiac injury repair to decrease mortality. Among 22 male patients requiring both thoracotomy and laparotomy, mortality was 18%, with all deaths occurring before the adoption of FAST and SPWs. The study concludes that these technological and clinical advances have lessened clinical uncertainty and improved outcomes in this high-risk patient group.