Cardiac injury: Difference between revisions
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**Combination of normal ECG and normal troponin 100% sn in one study | **Combination of normal ECG and normal troponin 100% sn in one study | ||
== | ==Management== | ||
*[[Thoracotomy]] | ===Penetrating Trauma=== | ||
*[[Pericardiocentesis]] | *Procedures | ||
**[[Thoracotomy]] | |||
**[[Pericardiocentesis]] | |||
==Blunt Trauma== | |||
*Observe all pts w/ cont cardiac monitoring and interval assessment of cardiac markers | |||
==Great Vessels Injury== | |||
*Aorta | |||
**Proximal descending aorta is most commonly injured in blunt trauma | |||
***Due to fixation of vessels between L subclavian artery and ligamentum arteriosum | |||
**Most pts die at the scene | |||
*Subclavian | |||
**Usually due to direct trauma or fx of first rib or clavicle | |||
**Loose shoulder restraint | |||
*IVC/SVC | |||
**Suspect if major hepatic injury or bleeding that cannot be identified | |||
==Diagnosis== | |||
*CXR | |||
**Mediastinum widening | |||
** | |||
Revision as of 21:05, 18 July 2011
Background
Penetrating Trauma
- Location
- Stab wounds
- Usually affect heart if enter via the "cardiac box"
- Chest area bounded by sternal notch, xiphoid, and nipple
- Usually affect heart if enter via the "cardiac box"
- GSW can affect heart even if enters at distant site
- Stab wounds
- Ventricles are at greatest risk due to anterior location
- RV (involved in 40% of injuries)
- LV (involved in 35% of injuries)
- RA (involved in 20% of injuries)
- LA (involved in 5% of injuries)
- Cardiac missiles
- Those that cause BP instability, free or partially exposed should be removed
- Most intramyocardial and intrapericadrial bullets can be left in place
Blunt Trauma
- Up to 20% of all MVC deaths are due to blunt cardiac injury
- Most often involves the right heart (due to ant location)
- Injury to valves occurs in 10%
- May present as:
- MI (coronary artery injury)
- Acute heart failure (valve rupture)
- Dysrhythmias
Workup
- FAST
- Pericardial fluid detection (Sn 100%, Sp 97%)
- ECG
- NPV for a normal ECG is 80-90%
- Not as sensitive for right-sided injuries
- Troponin
- Trend in all pts
- Combination of normal ECG and normal troponin 100% sn in one study
Management
Penetrating Trauma
- Procedures
Blunt Trauma
- Observe all pts w/ cont cardiac monitoring and interval assessment of cardiac markers
Great Vessels Injury
- Aorta
- Proximal descending aorta is most commonly injured in blunt trauma
- Due to fixation of vessels between L subclavian artery and ligamentum arteriosum
- Most pts die at the scene
- Proximal descending aorta is most commonly injured in blunt trauma
- Subclavian
- Usually due to direct trauma or fx of first rib or clavicle
- Loose shoulder restraint
- IVC/SVC
- Suspect if major hepatic injury or bleeding that cannot be identified
Diagnosis
- CXR
- Mediastinum widening
Disposition
See Also