Cardiac injury: Difference between revisions
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==Workup== | ==Workup== | ||
*CXR | |||
**Mediastinum widening is only suggestive of an aortic injury | |||
***Lack of widening does not rule out aortic injury | |||
*CTA | |||
**Imaging study of choice for penetrating and blunt trauma | |||
*FAST | *FAST | ||
**Pericardial fluid detection (Sn 100%, Sp 97%) | **Pericardial fluid detection (Sn 100%, Sp 97%) | ||
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==Management== | ==Management== | ||
===Penetrating Trauma=== | ===Penetrating Trauma=== | ||
**[[Thoracotomy]] | **[[Thoracotomy]] | ||
**[[Pericardiocentesis]] | **[[Pericardiocentesis]] | ||
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==Blunt Trauma== | ==Blunt Trauma== | ||
*Observe all pts w/ cont cardiac monitoring and interval assessment of cardiac markers | *Observe all pts w/ cont cardiac monitoring and interval assessment of cardiac markers | ||
==Great Vessels Injury== | ==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 | |||
* | *Control of BP and HR is important if operative management will be delayed | ||
== | ===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 | |||
==See Also== | ==See Also== | ||
[[Thoracic Trauma]] | |||
[[Commotio Cordis]] | [[Commotio Cordis]] | ||
==Source== | ==Source== | ||
Tintinalli | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Revision as of 21:20, 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
- CXR
- Mediastinum widening is only suggestive of an aortic injury
- Lack of widening does not rule out aortic injury
- Mediastinum widening is only suggestive of an aortic injury
- CTA
- Imaging study of choice for penetrating and blunt trauma
- 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
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
- Control of BP and HR is important if operative management will be delayed
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
See Also
Thoracic Trauma Commotio Cordis
Source
Tintinalli