Cardiac contusion

Background

• MVC with chest striking the steering wheel

Clinical Features

• Chest pain
• Palpitations
• Tachy
• Dyspnea/SOB

Differential Diagnosis

Thoracic Trauma

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

Diagnosis

• Physical
  • New murmur
• EKG
  • most common abnormality in order
    • Sinus tachy
    • PVCs
    • A. fib
  • Dysrythmia can be delayed for up to 12 hours
• Do NOT need enzymes but can help dx
  • Positive Trop
• Echo
  • Can aid in further determining the extent of damage

Treatment

1. Treat arrhythmia prn
   1. Do NOT treat prophylacticly (incr mort!)
2. NO thrombolitics for AMI here (incr mort)

severity depends on underlying cad b/c inflamm chngs= redistribute coronary flow that may= ischemic cp.

Disposition

Observation for 6 hours

Admit (tele) for:

1. abnl physical
2. abnl ekg
3. hypotension

See Also

Thoracic Trauma