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
   • Do NOT treat prophylacticly (increased mortality!)
2. NO thrombolitics for AMI here (increased mortality)

severity depends on underlying CAD because of inflammatory changes= redistribute coronary flow that may= ischemic cp.

Disposition

Observation for 6 hours

Admit for (telemetry bed):

• Abnormal physical
• Abnormal EKG
• Hypotension

See Also

Thoracic Trauma